宫颈液基细胞学中非典型腺细胞的形态结构特征与临床意义

Cytological features and clinical significance of atypical glandular cells on cervical liquid-based cytology

目的:探讨宫颈液基细胞学中非典型腺细胞诊断的临床意义,评估有临床意义的细胞学形态结构特征,研究细胞学中鉴别腺上皮细胞病变与鳞状细胞病变的形态线索。方法:对我院2011年至2019年液基细胞学筛查为非典型腺细胞(atypical glandular cell,AGC)的病例复阅,通过与组织学结果对照,评估相关的细胞学特征。结果:514例AGC患者中,组织学结果阳性232例(45.1%),包括腺细胞病变114例(22.2%),鳞状上皮细胞病变104例(20.2%),腺细胞病变合并鳞状上皮细胞病变11例(2.1%),其他恶性肿瘤3例(0.6%)。评估的11个细胞学特征中,有8个特征在良性变化和癌或癌前病变之间有显著的统计学差异(P<0.05),分别为失去极性、羽毛状结构、乳头样结构、核膜不规则、出现大核仁、粗糙的染色质、中性粒细胞口袋、细胞浆内大空泡。有6个与腺上皮病变相关,前3位依次是:中性粒细胞口袋、羽毛状结构、细胞浆内大空泡;有4个与鳞状上皮病变相关,前3位分别是:核膜不规则、核深染、粗糙的染色质;羽毛状结构对于区别腺上皮病变和鳞状上皮病变最有意义。结论:AGC随访恶性率高,细胞学中应重点关注失去极性、羽毛状结构、乳头样结构等8个特征,而拥挤重叠、核浆比升高、核深染不应作为评估肿瘤性变化的标准。

Objective:To investigate the clinical significance of atypical glandular cells(AGC)diagnosis in cervical liquid based cytology,evaluate the cytological morphological and structural characteristics with clinical significance,and study the morphological clues to differentiate glandular epithelial cell disease and squamous cell disease in cytology.Methods:Cases diagnosed with AGC by liquid-based cytology test in our hospital from 2011 to 2019 were reviewed.The relevant cytological characteristics were evaluted by comparing with histological results.Results:In the 514 patients with AGC,232 cases(45.1%)were histologically positive,including 114 cases(22.2%)for glandular lesions,104 cases(20.2%)for squamous lesions,11 cases(2.1%)for glandular lesions with squamous lesions,and 3 cases(0.6%)for other malignancies.In the 11 cytological features evaluated,loss of polarity,feathering,papillary pattern,irregular nuclear membrane,macronucleoli,chromatin coarsening,bag of polys cells,large cytoplasmic vacuolation were found to be significant in terms of premalignant or malignant lesions(P<0.05).6 of 11 cytological features were associated with glandular lesions,and the top three were bag of polys cells,feathering,large cytoplasmic vacuolation.Four of them were associated with squamous lesions,and the top three were irregular nuclear membrane,hyperchromasia,chromatin coarsening.Feathering was most useful for distinguishing glandular lesions from squamous lesions.Conclusion:A considerable risk is associated with AGC cytology.Eight characteristics such as loss of polarity,feathering and papillary pattern should be the focus of cytological evaluation,while overlapping,increased nucleocyto plasmic ratio,and hyperchromasia should not be used as the criteria for evaluating neoplastic changes.