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目的探讨宫颈细胞学不典型腺细胞(AGC)患者细胞学分类、病理分型与人乳头状瘤病毒(HPV)表达相关性及AGC患者的有效筛查。方法回顾性分析2008年10月至2009年10月于北京妇产医院接受宫颈细胞学检查并诊断包含AGC,且接受阴道镜检查、组织病理活检及HPV检测的患者321例,将病理结果、HPV表达情况同细胞学结果对比研究。结果 321例AGC患者中,AGC合并高度鳞状上皮内病变(HSIL)/可疑原位癌(CIS)组患病率83.3%(10/12),经χ2检验明显高于单纯AGC组的21.6%(30/139)及AGC合并ASCUS/LSIL组的29.4%(50/170),χ2=21.215,P<0.05。倾向瘤变的宫颈不典型腺细胞(AGC-FN)组及AGC可疑腺癌组患病率分别为48.6%(18/37)和50.0%(1/2),经χ2检验明显高于不典型腺细胞(AGC-NOS)组的23.1%(65/282),χ2=26.145,P<0.05。HPV对于AGC患者阳性病变检出灵敏度为43.3%;特异度为79.8%;阳性预测值为37.1%;阴性预测值为83.7%。结论需高度关注AGC合并HSIL以上鳞状上皮诊断,或分型为AGC-FN及AGC可疑腺癌的细胞学报告。高危型HPV检测在评价AGC中具有重要价值。
Objective To investigate the cytological classification of cervical cytological atypical gland cells (AGC), the correlation between pathological type and human papillomavirus (HPV) expression and the effective screening of AGC patients. Methods A retrospective analysis of 321 patients with cervical cytology who underwent cervical cytology at Beijing Maternity Hospital from October 2008 to October 2009 and who diagnosed AGC, colposcopy, histopathological biopsy and HPV testing was performed. Pathological findings, HPV Comparative study of expression and cytology results. Results Among 321 AGC patients, the prevalence of AGC with high grade squamous intraepithelial neoplasia (HSIL) / suspicious CIS (CIS) was 83.3% (10/12), significantly higher than that of the AGC group (21.6% (30/139) and 29.4% (50/170) of AGC combined ASCUS / LSIL group, χ2 = 21.215, P <0.05. The prevalence rates of AGC-FN and AGC suspicious adenocarcinoma were 48.6% (18/37) and 50.0% (1/2), respectively, which were significantly higher than those of atypical glandular cells 23.1% (65/282) of the AGC-NOS group, χ2 = 26.145, P <0.05. HPV positive rate of positive patients with AGC detection was 43.3%; specificity of 79.8%; positive predictive value of 37.1%; negative predictive value of 83.7%. CONCLUSIONS: Cytology of AGC with squamous metaplasia above HSIL or suspicious adenocarcinoma of AGC-FN and AGC should be highly concerned. High-risk HPV testing is of great value in the evaluation of AGC.