宫颈细胞学筛查中不典型腺细胞的临床意义

摘要

目的:探讨宫颈细胞学中不典型腺细胞(AGC)在筛查预防病变方面的临床价值.方法:对细胞学检查诊断为AGC的患者行宫颈活检+颈管搔刮、宫颈锥切、分段诊刮或子宫切除后的病理结果进行回顾性分析.结果:AGC检出率为0.6％(1016/157613).1016例AGC中有效随访病例962例,阳性病例302例,阳性率31.4％,其中鳞状上皮病变113例(37.4％),腺上皮病变173例(57.3％),其他16例(5.3％).370例≤40岁的患者中有效随访病例362例,阳性病例73例(20.2％),其中鳞状上皮病变45例(61.6％),腺上皮病变24例(32.9％),其他4例(5.5％);＞ 40岁的646例患者中有效随访病例600例,阳性病例229例(38.2％),其中鳞状上皮病变68例(29.7％),腺上皮病变154例(67.2％),其他7例(3.1％).AGC-倾向瘤变有效随访病例138例,阳性病例108例(阳性率78.3％),≤40岁和＞40岁分别以HSIL病变和子宫内膜癌检出率最高.结论:AGC的检出率低,≤40岁病例以鳞状上皮病变为主,＞40岁病例以腺上皮病变为主.AGC-倾向瘤变对宫颈及子宫内膜严重病变有非常重要的提示作用.%Objective:To explore the clinical value of atypical glandular cells in screening and preventing disease.Methods:The pathologic results of Cervical biopsy + neck scratch scraping,cervical cone cutting,curettage or hysterectomy after the cytology diagnosis with AGC were retrospectively analyzed.Results:There were 962 effective follow-up cases in the 1016 cases of atypical glandular cell,positive cases 302 cases and the positive rate of 31.4％.Among the 302 positive cases,therewere 11t3 squamous epithelial lesions cases(37.4％),173 glandular epithelial lesions cases (57.3％) and 16 other lesions cases (5.3％).AGC detection rate was 0.6％ (1016/157613).There were 362 effective follow-up cases in 370 cases of patients with the age ≤40,including 73 positive cases(20.2％).The 73 positive cases included 45 cases Squamous epithelial lesions(61.6％),24 patients glandular epithelial lesions(32.9％) and 4 other cases(5.5％).There were 600 effective follow-up cases in 646 cases of patients with the age ＞ 40,including 229 positive cases (38.2％).The 229 positive cases included 68 cases squamous epithelial lesions(29.7％),154 patients glandular epithelial lesions(67.2％) and 7 other cases(3.1％).There were 138 AGC-tendency neoplasia effective follow-up cases,which included 108 positive cases(positive rate 78.3％).The patients with 40 years old or less and ＞40 years old were the most frequently detected with HSIL pathological changes and endometrial carcinoma.Conclusions:AGC detection rate is low.The type of positive follow-up results are age-related,≤40 cases usually with squamous epithelial lesions and ＞40 cases usually with glandular epithelial lesions.AGC-tendency neoplasia has very important implication for cervical serious and endometrial disease.