子宮頸腺癌細胞學診斷與病理組織學的相關性：十年之回顧

The Correlation between Cytology and Histopathology of Primary Adenocarcinoma of the Uterine Cervix

陳娕茹(Shu-Ru Chen) ； 張銘城(Ming-Chen Chang) ； 何霖(William L. Ho)

《The Kaohsiung Journal of Medical Sciences》 10卷5期 (1994/05) Pp. 250-255

https://doi.org/10.6452/KJMS.199405.0250

摘要

細胞學診斷是一種步驟簡單、非侵犯性而且經濟的檢查方法，尤其是子宮頸抹片更可達到子宮頸癌篩檢的功效。腺癌為較少見之子宮頸原發性腫瘤，近年來有逐漸增加之趨勢。本文之第一部分是以台中榮民總醫院10年間組織切片診斷為子宮頸腺癌者共113例與其抹片細胞學之診斷比較，其中抹片診斷為腺癌者有62例，疑似腺癌有10例，其腺癌之抹片診斷率可達63.7%。抹片診斷不正確有41例佔36.3%；其中誤診為鱗狀上皮癌者有21例佔18.6%，異常病變（atypia）者有8例佔7.1%，陰性抹片者有8例佔7.1%，抹片檢體不足者有3例占2.7%，放射性細胞變化有1例佔0.8%。第二部分是以相同期間子宮頸抹片細胞學診斷為腺癌之82例與其切片診斷比較，切片結果分別為：腺癌者62例（75.6%），侵潤性鱗狀上皮癌者9例和鱗狀上皮原位癌者3例（14.6%），屬較嚴重誤診（偽陽性）者8例（9.8%）。文中並討論有關子宮頸腺癌細胞學診斷不足（underdiagnosis）和過度診斷（overdiagnosis）的原因，以及其形態學與率確度之相關性。本研究之數據顯示子宮頸抹片檢查可作為腺癌的篩檢、治療後的追蹤和復發時的確認之常規檢查法。為增加診斷腺癌之準確度必須加強篩檢技術員與病理醫師對於腺癌細胞形態學的認識。

並列摘要

Cytodiagnosis is a simple, non-invasive and economical screening method for uterine cervical malignancy. Adenocarcinoma as a primary tumor of uterine cervix, although relatively rare, is increasing recently. The first part of the study consisted of 113 patients, seen during a 10-year period, with adenocarcinoma of the uterine cervix proven by tissue diagnosis with prior and/or coincident Papanicolaou smears available in our hospital. Their cytology were as follows: positive/suspicious for adenocarcinoma in 72 cases (63.7%) and incorrect diagnosis for adenocarcinoma in 41 cases (36.3%). These included epidermoid carcinoma, 21 cases (18.6%); atypia, 8 cases (7.1%); negative smears, 8 cases (7.1%); inadequate specimens, 3 cases (2.7%) and radiation effect, 1 case (0.8%). The second part of the study is concerned with the 82 cases whose smear diagnosis was adenocarcinoma in the same period. The results of their tissue diagnosis and accuracy were as follows: adenocarcinoma in 62 cases (75.6%); epidermoid carcinoma in 9 and epidermoid carcinoma in situ in 3 cases totalling 12 cases (14.6%); and false positive in 8 cases (9.8%). The cytomorphology and its correlation to underdiagnosis and over- diagnosis is discussed. Our data revealed that cervicovaginal smears served as a routine for the screening of primary adenocarcinoma of the uterine cervix and for follow-up and detection of recurrence. In order to increase the accuracy, screening cytotechnicians and cytopathologists should acquaint themselves with the morphology of cervical adenocarcinoma by comparing cervicovaginal smear with histopathology.

並列關鍵字

cytology ； uterine cervix ； adenocarcinoma