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21 楼发表于2009-06-12 22:26:00举报|引用
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Table 2.

hrHPV Prevalence in Older and Younger Women with ASC-H TPPT (Two Age Groups)

Age groups

hrHPV tested

Positive

%

95% CI

P value

<30

556

340

61.2

57.1-65.3

<.001

≥30

631

249

39.5

35.7-43.3

<40

858

469

54.7

51.4-58.0

<.001

≥40

329

120

36.5

31.3-41.7

hrHPV indicates high risk human papillomavirus; ASC-H, atypical squamous cells, cannot exclude high- grade squamous intraepithelial lesion; TPPT, ThinPrep Pap tests.

Table 3.

Histologic Follow-up Results in Women with ASC-H Comparing hrHPV Positive and Negative Groups Stratified by Ages

Age

hrHPV Positive

hrHPV Negative

P value

(CIN 2/3)

P value

(CIN 1)

F/U No.

CIN 2/3

(%)

CIN 1

(%)

F/U No.

CIN 2/3

(%)

CIN 1

(%)

10-19

19

2

(10.5)

6

(31.6)

5

0

20-29

118

40

(33.9)

37

(31.4)

79

0

19

(24.1)

<.001

0.27

30-39

67

31

(46.3)

18

(26.9)

73

3

(4.1)

7

(9.6)

<.001

.008

40-49

33

8

(24.2)

10

(30.3)

52

0

2

(3.8)

<.001*

.001*

50-59

12

3

(25.0)

4

(33.3)

21

0

4

(19.0)

60-69

6

0

1

(16.7)

10

0

70-79

2

0

8

0

257

84

(32.7)

76

(29.2)

248

3

(1.2)

32

(12.9)

<.001

*Fisher’s exact test

hrHPV indicates high risk human papillomavirus; ASC-H, atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion; TPPT, ThinPrep Pap tests; CIN 1, cervical intraepithelial neoplasm 1; CIN 2/3,cervical intraepithelial neoplasm 2 or 3; F/U, follow-up.

Table 4.

Histologic Follow-up Results Comparing Women with ASC-H TPPT Age 40 and Older with Younger Women

Age groups

F/U

No.

CIN 2/3

CIN 1

No.

%

95% CI

P value

No.

%

95% CI

P value

<40

361

76

21.1

16.9-25.3

<.001

87

24.1

19.7-28.5

.019

≥40

144

11

7.6

3.3-11.9

21

14.6

8.8-20.4

Total

505

87

17.2

13.9-20.5

108

21.4

17.8-25.0

ASC-H indicates atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion; TPPT, ThinPrep Pap tests; CIN 1, cervical intraepithelial neoplasm 1; CIN 2/3, cervical intraepithelial neoplasm 2 or 3; F/U, follow-up.

Table 5.

Histologic Follow-up Results in Women with ASC-H TPPT with and without EC/TZS

EC/TZS Present

EC/TZS Absent

P value

Total No.

CIN 2-3

(%)

CIN 1

(%)

Total No.

CIN 2/3

(%)

CIN 1

(%)

CIN 2/3

CIN 1

<30

203

38

(18.7)

54

(26.6)

18

4

(22.2)

8

(44.4)

.75

.11

≥30

267

41

(15.4)

43

(16.1)

17

4

(23.5)

3

(17.6)

.37

.74*

Total

470

79

(16.8)

97

(20.6)

35

8

(22.9)

11

(31.4)

.36

.13

*Fisher’s exact test.

ASC-H indicates atypical squamous cells, cannot exclude high grade squamous intraepithelial lesion; TPPT, ThinPrep Pap tests; EC/TZS, endocervical/transformation zone sample; CIN 1, cervical intraepithelial neoplasm 1; CIN 2/3, cervical intraepithelial neoplasm 2 or 3; F/U, follow-up.

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22 楼发表于2009-06-12 22:24:00举报|引用
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Table 1.

hrHPV Prevalence in Women with ASC-H TPPT with and without TZ/ECS

(10 Year Interval)

Age

Total

EC/TZS present

EC/TZS absent

P value

hrHPV tested

Positive

%

95% CI

hrHPV tested

Positive

%

hrHPV tested

Positive

%

10-19

68

56

82.4

73.3-91.5

64

52

81.3

4

100.0

>.99*

20-29

488

284

58.2

53.8-62.6

453

263

58.1

35

21

60.0

.86

30-39

302

129

42.7

37.1-48.3

282

118

41.8

20

11

55.0

.35

40-49

195

68

34.9

28.2-41.6

184

64

34.8

11

4

36.4

.92

50-59

89

36

40.4

30.2-50.6

75

29

38.7

14

7

50.0

.43

60-69

30

13

43.3

25.6-61.0

26

11

42.3

4

2

50.0

>.99*

70-79

15

3

20.0

0-

40.2

15

3

20.0

0

Total

1187

589

49.6

46.8-52.4

1099

540

49.1

88

49

55.7

.24

*Fisher’s exact test

EC/TZS indicates endocervical/transformation zone sample; hrHPV, high risk human papillomavirus; ASC-H, atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion; TPPT, ThinPrep Pap tests

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23 楼发表于2009-06-12 22:22:00举报|引用
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本帖最后由于 2009-06-28 13:15:00 编辑 Arch Pathol Lab Med.

Erratum in:: Arch Pathol Lab Med. 2009 Feb;133(2):175.

Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results.（在巴氏结果为ASC-H的女性辅助HPV-DNA检测在一些临床疾病的风险评估和分流的作用）

Bandyopadhyay S, Austin RM, Dabbs D, Zhao C.

Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.

CONTEXT: Recent guidelines recommend colposcopy for women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). objective: To determine whether adjunctive high-risk human papillomavirus (hrHPV) testing is useful for disease risk assessment in females with ASC-H Papanicolaou (Pap) test results. DESIGN: High-risk HPV prevalence and histopathologic follow-up data on 1187 females with ASC-H ThinPrep Pap test (TPPT) and hrHPV test results were analyzed. RESULTS: ASC-H was reported in 1646 (0.59%) [corrected] of 277 400 (270 338 TPPT and 7062 conventional) Pap test results. The difference in ASC-H detection rates between TPPTs and conventional Pap smears was statistically significant (0.60% vs 0.38%; P = .02). High-risk HPV was detected in 589 (49.6%) of 1187 females with ASC-H TPPT and hrHPV testing. The hrHPV DNA-positive rate in females younger than 40 years was 54.7%, significantly higher than the 36.5% in women 40 years and older. Among 505 females with histopathologic follow-up, cervical intraepithelial neoplasia 2/3 was identified in 32.7% of hrHPV-positive females compared with 1.2% in hrHPV-negative females. The sensitivity, specificity, positive predictive value, and negative predictive value of ASC-H cytology in conjunction with hrHPV DNA testing results for detection of cervical intraepithelial neoplasia 2/3 were 96.1% versus 100.0%, 54.0% versus 68.4%, 35.8% versus 20.8%, and 98.1% versus 100.0% in females younger than 40 years and women 40 years and older, respectively. CONCLUSIONS: Our data suggest that reflex hrHPV testing is a highly useful option for women with ASC-H Pap tests. Females with ASC-H and negative hrHPV testing may be more efficiently managed by follow-up with regular Pap and hrHPV testing rather than universal colposcopy, especially for women 40 years and older.（结论：我们的数据表明：对巴氏结果为ASC-H的女性进行高危HPV检测的结果反馈证明是非常有用的。巴氏结果为ASC-H而高危HPV检测结果为阴性的女性通过规则的巴氏筛查和高危HPV检测比普通的阴道镜可更有效的管理；特别是对40岁及以上的女性。）

Arch Pathol Lab Med. 2008 Dec;132(12):1874-81.

Erratum in:: Arch Pathol Lab Med. 2009 Feb;133(2):175.

Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results.（在巴氏结果为ASC-H的女性辅助HPV-DNA检测在一些临床疾病的风险评估和分流的作用）

Bandyopadhyay S, Austin RM, Dabbs D, Zhao C.

Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.

CONTEXT: Recent guidelines recommend colposcopy for women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). objective: To determine whether adjunctive high-risk human papillomavirus (hrHPV) testing is useful for disease risk assessment in females with ASC-H Papanicolaou (Pap) test results. DESIGN: High-risk HPV prevalence and histopathologic follow-up data on 1187 females with ASC-H ThinPrep Pap test (TPPT) and hrHPV test results were analyzed. RESULTS: ASC-H was reported in 1646 (0.59%) [corrected] of 277 400 (270 338 TPPT and 7062 conventional) Pap test results. The difference in ASC-H detection rates between TPPTs and conventional Pap smears was statistically significant (0.60% vs 0.38%; P = .02). High-risk HPV was detected in 589 (49.6%) of 1187 females with ASC-H TPPT and hrHPV testing. The hrHPV DNA-positive rate in females younger than 40 years was 54.7%, significantly higher than the 36.5% in women 40 years and older. Among 505 females with histopathologic follow-up, cervical intraepithelial neoplasia 2/3 was identified in 32.7% of hrHPV-positive females compared with 1.2% in hrHPV-negative females. The sensitivity, specificity, positive predictive value, and negative predictive value of ASC-H cytology in conjunction with hrHPV DNA testing results for detection of cervical intraepithelial neoplasia 2/3 were 96.1% versus 100.0%, 54.0% versus 68.4%, 35.8% versus 20.8%, and 98.1% versus 100.0% in females younger than 40 years and women 40 years and older, respectively. CONCLUSIONS: Our data suggest that reflex hrHPV testing is a highly useful option for women with ASC-H Pap tests. Females with ASC-H and negative hrHPV testing may be more efficiently managed by follow-up with regular Pap and hrHPV testing rather than universal colposcopy, especially for women 40 years and older.（结论：我们的数据表明：对巴氏结果为ASC-H的女性进行高危HPV检测的结果反馈证明是非常有用的。巴氏结果为ASC-H而高危HPV检测结果为阴性的女性通过规则的巴氏筛查和高危HPV检测比普通的阴道镜可更有效的管理；特别是对40岁及以上的女性。）

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24 楼发表于2009-06-12 22:20:00举报|引用
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Table 1

Correlation of the Sub-Categories of 460 AGC Cases with Preneoplastic or Neoplastic Lesions in Tissue Biopsies

AGC & ASC-US

(n=68)

AGC-EM

(n=36)

AGC-NOS

(n=187)

AGC-EC

(n=169)

Total

(n=460)

Squamous cell lesions

9 (13.2%)

1 (2.8%)

6 (3.2%)

10 (5.9%)

26 (5.7%)

Invasive squamous

carcinoma

1 (0.6%)

1 (0.2%)

CIN 2,3

9 (13.2%)

1 (2.8%)

6 (3.2%)

9 (5.3%)

25 (5.4%)

Cervical glandular lesions

0

5 (2.7%)

14 (8.3%)

19 (4.1%)

AIS

1 (0.5%)

4 (2.4%)

5 (1.1%)

Invasive carcinoma

4 (2.1%)

9*(5.3%)

13(2.8%)

MMMT

1 (0.6%)

1 (0.2%)

Endometrial lesions

3 (4.4%)

19 (52.8%)

30 (16.0%)

2 (1.2%)

54 (11.7%)

Atypical complex hyperplasia

3 (4.4%)

8 (22.2%)

8 (4.3%)

1 (0.6%)

20 (4.3%)

Endometrioid carcinoma

10 (27.8%)

19 (10.2%)

1 (0.6%)

30 (6.5%)

MMMT

1 (2.8%)

1 (0.5%)

2 (0.4%)

Complete mole

1 (0.5%)

1 (0.2%)

Choriocarcinoma

1 (0.5%)

1 (0.2%)

Ovarian lesions

0

1 (2.8%)

4 (2.1%)

1 (0.6%)

6 (1.3%)

Serous carcinoma

1 (2.8%)

2 (1.1%)

1 (0.6%)

4 (0.9%)

Endometrioid carcinoma

1 (0.5%)

1 (0.2%)

Clear cell carcinoma

1 (0.5%)

1 (0.2%)

Total

12 (17.6%)

21 (58.3%)

45 (24.1%)

27 (16.0%)

105 (22.8%)

AGC, atypical glandular cells; ASC-US, atypical squamous cells of undetermined significance; AGC-EM, atypical glandular cells, endometrial origin; AGC-EC, atypical glandular cells, endocervical origin; AGC-NOS, atypical glandular cells, not otherwise specified; CIN, cervical intraepithelial neoplasia; MMMT, malignant müllerian mixed tumor; AIS, adenocarcinoma in situ.

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25 楼发表于2009-06-12 22:20:00举报|引用
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Table 2

The Relation of Age and Subsequent Significant Histologic Diagnosis in Women with AGC Paps

	<35 (n=80)	35-50 (n=262)	>50 (n=118)	Total (n=460)
CIN 2,3 or above	8 (10.0%)	11 (4.2%)	7(5.9%)	26 (5.7%)
AIS	2 (2.5%)	2 (0.8%)	1 (0.8%)	5 (1.1%)
Endocervical invasive tumor	0	5 (1.9%)	9 (7.7%)	14* (3.0%)
ACH	0	13 (5.0%)	7 (5.9%)	20 (4.3%)
Endometrial malignancy	0	9 (3.4%)	24 (20.3%)	33† (7.2%)
Ovarian carcinoma	0	2 (0.8%)	4 (3.4%)	6 (1.3%)
Complete mole	1 (1.2%)	0	0	1 (0.2%)
Total lesions	11 (13.8%)	42 (16.0%)	52 (45.8%)	105 (22.8%)

AGC, atypical glandular cells; CIN, cervical intraepithelial neoplasia; AIS, adenocarcinoma in situ; ACH, atypical complex hyperplasia.

* Including 13 cases of invasive endocervical carcinoma and one case of malignant müllerian mixed tumor.

† Including 30 cases of endometrioid carcinoma, 2 cases of malignant müllerian mixed tumor, and one case of choriocarcinoma.

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26 楼发表于2009-06-12 22:15:00举报|引用
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本帖最后由于 2009-06-28 12:51:00 编辑 Acta Cytol. 2009 Mar-Apr;53(2):153-9.

Clinical significance of atypical glandular cells in conventional pap smears in a large, high-risk U.S. west coast minority population.(在一个大型、高危的美国西海岸少数民族人群中传统巴氏涂片为AGC的临床意义)

Zhao C, Austin RM, Pan J, Barr N, Martin SE, Raza A, Cobb C.

Department of Pathology, Los Angeles County and University of Southern California Medical Center, USA. zhaoc@upmc.edu

OBJECTIVE: To determine the incidence of clinically significant lesions on subsequent histologic follow-up in high-risk, predominantly minority patients with atypical glandular cells (AGC). STUDY DESIGN: A retrospective study was done on conventional Pap smears diagnosed as AGC of endocervical origin (AGC-EC), AGC of endometrial origin (AGC-EM) and AGC not otherwise specified (AGC-NOS) between January 1, 2003, and December 31, 2005. Histologic diagnoses were correlated with cytologic diagnoses. RESULT: Confirmed AGC cases were divided into 4 categories: 187 AGC-NOS, 169 AGC-EC, 68 AGC and atypical squamous cells of undetermined significance (ASCUS) and 36 AGC-EM. A total of 105 patients (22.8%) had significant precancerous (cervical intraepithelial neoplasia [CIN] 2/3, adenocarcinoma in situ [AIS]) or malignant (carcinoma) histologic outcomes. CIN 2/3 was the most common significant histologic outcome in women with AGC and ASCUS and patients <35 years with AGC. Endometrial neoplasia was the most common significant outcome in women with AGC-NOS and AGC-EM Pap results and in AGC patients > or =35. In women with AGC-EC Pap results, glandular cervical neoplasia occurred in 8.3% and CIN 2/3 in 5.9% offollow-up biopsies. CONCLUSION: AGC subtype and age significantly affect the probability of precancerous and malignant follow-up findings and anatomic site of neoplastic lesions. Access to newer screening technologies such as high-risk HPVDNA testing and liquid-based cytology will likely benefit such high-risk populations.（结论：在癌前病变和肿瘤的随访中发现，AGC的亚型、病人的年龄和肿瘤病灶解剖部位的可能性影响。进行新的筛查技术比如高危HPV检测和液基细胞学检测会使这种高危人群收益。）

Acta Cytol. 2009 Mar-Apr;53(2):153-9.

Clinical significance of atypical glandular cells in conventional pap smears in a large, high-risk U.S. west coast minority population.(在一个大型、高危的美国西海岸少数民族人群中传统巴氏涂片为AGC的临床意义)

Zhao C, Austin RM, Pan J, Barr N, Martin SE, Raza A, Cobb C.

Department of Pathology, Los Angeles County and University of Southern California Medical Center, USA. zhaoc@upmc.edu

OBJECTIVE: To determine the incidence of clinically significant lesions on subsequent histologic follow-up in high-risk, predominantly minority patients with atypical glandular cells (AGC). STUDY DESIGN: A retrospective study was done on conventional Pap smears diagnosed as AGC of endocervical origin (AGC-EC), AGC of endometrial origin (AGC-EM) and AGC not otherwise specified (AGC-NOS) between January 1, 2003, and December 31, 2005. Histologic diagnoses were correlated with cytologic diagnoses. RESULT: Confirmed AGC cases were divided into 4 categories: 187 AGC-NOS, 169 AGC-EC, 68 AGC and atypical squamous cells of undetermined significance (ASCUS) and 36 AGC-EM. A total of 105 patients (22.8%) had significant precancerous (cervical intraepithelial neoplasia [CIN] 2/3, adenocarcinoma in situ [AIS]) or malignant (carcinoma) histologic outcomes. CIN 2/3 was the most common significant histologic outcome in women with AGC and ASCUS and patients <35 years with AGC. Endometrial neoplasia was the most common significant outcome in women with AGC-NOS and AGC-EM Pap results and in AGC patients > or =35. In women with AGC-EC Pap results, glandular cervical neoplasia occurred in 8.3% and CIN 2/3 in 5.9% offollow-up biopsies. CONCLUSION: AGC subtype and age significantly affect the probability of precancerous and malignant follow-up findings and anatomic site of neoplastic lesions. Access to newer screening technologies such as high-risk HPVDNA testing and liquid-based cytology will likely benefit such high-risk populations.（结论：在癌前病变和肿瘤的随访中发现，AGC的亚型、病人的年龄和肿瘤病灶解剖部位的可能性影响。进行新的筛查技术比如高危HPV检测和液基细胞学检测会使这种高危人群收益。）

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27 楼发表于2009-06-12 22:14:00举报|引用
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Table 2. Follow-up Pap Test and Biopsy Results for Unsatisfactory Cases

Initial Cytologic diagnosis Cervical biopsy

hrHPV test ASC-US LSIL Negative Unsatisfactory CIN 1*

Positive (n=11) 1 (9.1%) 4 (36.4%) 6 (54.5%) 0 5 (45.5%)

Negative (n=205) 6 (2.9%) 193 (94.2%) 6 (2.9%) 1 (0.5%)

Total (n=216) 7 (3.2%) 4 (1.9%) 199 (92.1%) 6 (2.8%) 6 (2.8%)

*In initial hrHPV positive group, all four cases with LSIL and one with ASC-US in the repeated Pap tests had CIN 1 confirmed by colposcopic cervical biopsy in histologic follow-up; In initial hrHPV negative group, one of ASC-US cases was diagnosed as CIN 1 in histologic follow-up and hrHPV positive.

hrHPV, high risk human papillomavirus; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; CIN, cervical intraepithelial neoplasia.

Table 3. Follow-up hrHPV DNA Test Results for Unsatisfactory Cases

Initial

hrHPV test Repeated case No Repeated hrHPV positive P value

Positive 6 3 (50%)

Negative 99 4 (4.0%) 0.0034

Total 105 7 (6.7%)

hrHPV, high risk human papillomavirus.

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28 楼发表于2009-06-12 22:13:00举报|引用
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Table 1. Reasons for Unsatisfactory Classification

Reasons*

HR HPV-

n=293 (96.4%)

HR HPV+

n=11 (3.6%)

Total

N=304

Inadequate squamous component

269

(91.8%)

7

(63.6%)

276

(90.8%)

Blood

31

(10.6%)

0

31

(10.2%)

inflammation

26

(8.9%)

1

(9.1%)

27

(8.9%)

Thick preparation

5

(1.7%)

2

(1.8%)

7

(2.3%)

Bacteria

3

(1.0%)

1

(9.1%)

4

(1.3%)

Cytolysis

2

(0.7%)

1

(9.1%)

3

(1.0%)

Two factors*

43

(14.7%)

1

(9.1%)

44

(14.5%)

*The lists include cases with two factors.

HR HPV, high risk human papillomavirus.

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29 楼发表于2009-06-12 22:11:00举报|引用
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本帖最后由于 2009-06-14 13:34:00 编辑 J Low Genit Tract Dis. 2009 Apr;13(2):79-84.

High-risk human papillomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results.

Zhao C, Austin RM.

Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. zhaoc@UPMC.edu

OBJECTIVES: This study assesses whether high-risk human papillomavirus (HPV) DNA test results from residual vial fluid of unsatisfactory liquid-based cytology(LBC) samples might provide useful information on disease risk. MATERIALS AND METHODS: Patients with unsatisfactory imaged ThinPrep Pap test results and available Hybrid Capture 2 high-risk HPV results were identified at an academic women's hospital laboratory between July 1, 2005, and July 31, 2007. Follow-up repeat cytology results, HPV results, and available biopsy results were analyzed. RESULTS: Three hundred four patients with unsatisfactory cytology results and HPV test results were studied. Eleven (3.6%) of 304 tested positive for HPV DNA, and 293 tested HPV negative. Five (45%) of 11 HPV-positive patients had detectible low-grade squamous intraepithelial/cervical intraepithelial neoplasia 1 during a mean follow-up period of almost 6 months. Among 293 women with negative HPV results, only 1 case of cervical intraepithelial neoplasia 1 was identified during roughly the same follow-up period. CONCLUSIONS: A positive high-risk HPV result associated with an unsatisfactory ThinPrep Pap test result identified patients at risk for diagnosis of an undetected squamous intraepithelial/cervical intraepithelial neoplasia. Negative high-risk HPV results associated with an unsatisfactory LBC had high negative predictive value in this limited study. The overall low detection rate for significant disease on follow-up of all patients with unsatisfactory imaged LBC is similar to findings reported in another LBC study but differs from studies reporting increased risk for undetected disease in women screened with unsatisfactory conventional Pap smears.

对于宫颈液基细胞学检测不满意的病人进行高危HPV-DNA检测是非常有用的宫颈疾病风险评估指标

目的：本文对宫颈液基细胞学检测不满意病人的剩余标本进行了高危HPV-DNA检测，评估高危HPV-DNA检查结果能否对宫颈疾病检查提供有用信息。

方法：将某妇科教学医院2005年1月1日至2007年1月30日的宫颈液基细胞学检测不满意的标本和相应的HC-II高危HPV基因检测结果进行分析，后续随访包括细胞学重复检测，HPV检测及宫颈活检。

结果：细胞学筛查不满意和同时进行了HPV基因检测的共304例病人，其中11例（11/304，3.6%） HPV基因检测阳性，293例基因检测阴性。11例阳性病人中5例（45%）在后续的平均时间为6个月的随访中检测到低级别宫颈上皮内瘤变（CIN-I）。在293例基因检测阴性妇女中，在相同时间的后续随访中，只有1例检测到低级别宫颈上皮内瘤变（CIN-I）。

结论：在本研究有限的病例中发现，宫颈细胞学筛查不满意伴高危HPV基因检测阳性妇女发生未检测到宫颈上皮内瘤变的机率较高，宫颈细胞学筛查不满意伴高危HPV基因检测阴性妇女发生未检测到宫颈上皮内瘤变的机率较低。总体上看，宫颈细胞学筛查不满意后续随访检测到的宫颈病变率较低，该结果与另外的某项液基细胞学（LBC）研究结果相似，但是与其它的研究结果不同，即传统宫颈细胞学涂片不满意时未检测到的宫颈病变发生率增加。

(laurelshihxbl翻译)

J Low Genit Tract Dis. 2009 Apr;13(2):79-84.

High-risk human papillomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results.

Zhao C, Austin RM.

Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. zhaoc@UPMC.edu

OBJECTIVES: This study assesses whether high-risk human papillomavirus (HPV) DNA test results from residual vial fluid of unsatisfactory liquid-based cytology(LBC) samples might provide useful information on disease risk. MATERIALS AND METHODS: Patients with unsatisfactory imaged ThinPrep Pap test results and available Hybrid Capture 2 high-risk HPV results were identified at an academic women's hospital laboratory between July 1, 2005, and July 31, 2007. Follow-up repeat cytology results, HPV results, and available biopsy results were analyzed. RESULTS: Three hundred four patients with unsatisfactory cytology results and HPV test results were studied. Eleven (3.6%) of 304 tested positive for HPV DNA, and 293 tested HPV negative. Five (45%) of 11 HPV-positive patients had detectible low-grade squamous intraepithelial/cervical intraepithelial neoplasia 1 during a mean follow-up period of almost 6 months. Among 293 women with negative HPV results, only 1 case of cervical intraepithelial neoplasia 1 was identified during roughly the same follow-up period. CONCLUSIONS: A positive high-risk HPV result associated with an unsatisfactory ThinPrep Pap test result identified patients at risk for diagnosis of an undetected squamous intraepithelial/cervical intraepithelial neoplasia. Negative high-risk HPV results associated with an unsatisfactory LBC had high negative predictive value in this limited study. The overall low detection rate for significant disease on follow-up of all patients with unsatisfactory imaged LBC is similar to findings reported in another LBC study but differs from studies reporting increased risk for undetected disease in women screened with unsatisfactory conventional Pap smears.

对于宫颈液基细胞学检测不满意的病人进行高危HPV-DNA检测是非常有用的宫颈疾病风险评估指标

目的：本文对宫颈液基细胞学检测不满意病人的剩余标本进行了高危HPV-DNA检测，评估高危HPV-DNA检查结果能否对宫颈疾病检查提供有用信息。

方法：将某妇科教学医院2005年1月1日至2007年1月30日的宫颈液基细胞学检测不满意的标本和相应的HC-II高危HPV基因检测结果进行分析，后续随访包括细胞学重复检测，HPV检测及宫颈活检。

结果：细胞学筛查不满意和同时进行了HPV基因检测的共304例病人，其中11例（11/304，3.6%） HPV基因检测阳性，293例基因检测阴性。11例阳性病人中5例（45%）在后续的平均时间为6个月的随访中检测到低级别宫颈上皮内瘤变（CIN-I）。在293例基因检测阴性妇女中，在相同时间的后续随访中，只有1例检测到低级别宫颈上皮内瘤变（CIN-I）。

结论：在本研究有限的病例中发现，宫颈细胞学筛查不满意伴高危HPV基因检测阳性妇女发生未检测到宫颈上皮内瘤变的机率较高，宫颈细胞学筛查不满意伴高危HPV基因检测阴性妇女发生未检测到宫颈上皮内瘤变的机率较低。总体上看，宫颈细胞学筛查不满意后续随访检测到的宫颈病变率较低，该结果与另外的某项液基细胞学（LBC）研究结果相似，但是与其它的研究结果不同，即传统宫颈细胞学涂片不满意时未检测到的宫颈病变发生率增加。

(laurelshihxbl翻译)

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30 楼发表于2009-06-12 22:07:00举报|引用
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Table 3

The Relation of Age and Subsequent Preneoplastic or Neoplastic lesions in tissue biopsies in Women with AGC Paps

Histopathology

Result ▼

Age<40 years

N=201

≥40 to <50 years

N=248

≥50

N=213

Total

N=662

CIN 2/3 and invasive

Squamous carcinoma

31*

(15.4%)

7**

(2.8%)

4

(1.9%)

42***

(6.3%)

Adenocarcinoma

In situ

8*

(4.0%)

8**

(3.2%)

0

(0%)

16***

(2.4%)

Invasive Cervical Adenocarcinoma

2

(1.0%)

1

(0.4%)

2

(0.9%)

5#

(0.8%)

Atypical Endometrial

Hyperplasia

0

(0%)

3

(1.2%)

5

(2.3%)

8

(1.2%)

Endometrial carcinoma

2

(1.0%)

5

(2.0%)

27

(12.7%)

34

(5.1%)

Ovarian

carcinoma

0

(0%)

1

(0.4%)

3

(1.4%)

4

(0.6%)

Total

38

(18.9%)

22

(8.9%)

41

(19.2%)

101

(15.3%)

* 5 cases with both AIS and CIN 2/3

** 3 cases with both AIS and CIN 2/3

*** Total 8 cases have both AIS and CIN2/3.

# 4 cases of adenocarcinoma, 1 case of adenosquamous carcinoma.

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31 楼发表于2009-06-12 22:06:00举报|引用
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Table 2.

Correlation of the subcategories of 662 AGC cases with precancerous or cancerous lesions in tissue biopsies

Cytologic Dx

AGC/ASC-US

(n=102)

AGC/ASC-H

(n=41)

AGC/HSIL

(n=28)

AGC-EM

(n=99)

AGC-EC

(n=131)

AGC-NOS

(n=261)

Total

(n=662)

CIN2+

3*

(2.9%)

3*

(7.3%)

18**

(64.3%)

0

9*

(6.9%)

9

(3.5%)

42***

(6.3%)

AIS+

1*

(1.0%)

3*

(7.3%)

5**

(17.9%)

0

8*

(6.1%)

4

(1.5%)

21***

(3.2%)

ACH+

3

(2.9%)

0

1

(3.6%)

22

(22.2%)

1

(0.8%)

15

(5.7%)

42

(6.3%)

Metastatic

1

(1.0%)

0

1

(1.0%)

1

(0.8%)

1

(0.4%)

4

(0.6%)

Total

7

(6.9%)

5

(12.2%)

19

(67.9%)

23

(23.2%)

18

(13.7%)

29

(11.1%)

101

(15.3%)

* 1 patient has both AIS and CIN2,3.

**5 patients have both AIS and CIN2,3.

*** in total 8 patients have both AIS and CIN2,3.

Abbreviation: CIN2+, cervical intraepithelial neoplasia 2 above squamous lesions; AIS+, endocervical adenocarcinoma and invasive carcinoma; CAH+, complex atypical hyperplasia above endometrial lesions.

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32 楼发表于2009-06-12 22:05:00举报|引用
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Table 1. AGC Subclassification and Subsequent Significant Surgical Diagnosis in 662 cases

Pap Result ►

AGC/ASC-US

(n=102)

AGC/ASC-H

(n=41)

AGC/HSIL

(n=28)

AGC-EM

(n=99)

AGC-EC

(n=131)

AGC-NOS

(n=261)

Total

(n=662)

Age ►

Histopathology

Result ▼

45.2

(19-84)

39.4

(21-76)

38.7

(24-45)

53.6

(35-77)

39.2

(19-72)

48.3

(27-84)

45.9

(19-84)

Cervical (Cx) Squamous Neoplasia

20

(19.6%)

14

(34.1%)

26

(92.9%)

1

(1.0%)

46

(35.1%)

44

(16.9%)

151

(22.8%)

Cx Squamous Carcinoma

1

(3.9%)

1

(0.2%)

CIN2/ 3

3*

(2.9%)

3*

(7.3%)

17**

(60.7%)

9*

(6.9%)

9

(3.4%)

41***

(6.2%)

CIN1

17

(16.7%)

11

(26.8%)

8

(28.6%)

1

(1.0%)

37

(28.2%)

35

(13.4%)

109

(16.5%)

Cx Glandular Neoplasia

1

(1.0%)

3

(7.3%)

5

(17.9%)

0

8

(6.1%)

4

(1.5%)

21

(3.2%)

AIS

1*

(1.0%)

2*

(4.9%)

5**

(17.9%)

5*

(3.8%)

3

(1.2%)

16***

(2.4%)

Cervical Adenocarcinoma

3

(2.3)

1

(0.4%)

4

(0.6%)

Cervical Adenosquamous Carcinoma

1

(2.4%)

1

(0.2)

Endometrial (EM) Neoplasia

6

(5.9%)

0

1

(3.6%)

28

(28.3%)

1

(0.8%)

18

(6.9%)

54

(8.2%)

Endometrial Adenocarcinoma

3

(2.9%)

1

(3.6%)

16

(16.2%)

14

(5.4%)

34

(5.1%)

Atypical Endometrial Hyperplasia

6

(6.1%)

1

(0.8%)

1

(0.4%)

8

(1.2%)

Complex Em Hyperplasia without atypia

2

(2.0%)

4

(4.0%)

1

(0.4%)

7

(1.1%)

Simple Em Hyperplasia without atypia

1

(1.0%)

2

(2.0%)

2

(0.8%)

5

(0.6%)

Ovarian Neoplasia

1

(1.0)

0

1

(1.0%)

1

(0.8%)

1

(0.4%)

4

(0.6%)

Ovarian Serous Adenocarcinoma

1

(1.0%)

1

(0.8%)

1

(0.4%)

3

(0.5%)

Ovarian Clear Cell Carcinoma

1

(1.0%)

1

(0.2%)

Total

27

(26.5%)

16*

(39.0%)

27**

(96.4%)

30

(30.3%)

55*

(42.0%)

67

(25.7%)

222***

(33.5%)

*1 with AIS and CIN2/3 **5 with AIS and CIN2/3 *** 8 with both AIS and CIN2,3

Table 1. AGC Subclassification and Subsequent Significant Surgical Diagnosis in 662 cases

Pap Result ►

AGC/ASC-US

(n=102)

AGC/ASC-H

(n=41)

AGC/HSIL

(n=28)

AGC-EM

(n=99)

AGC-EC

(n=131)

AGC-NOS

(n=261)

Total

(n=662)

Age ►

Histopathology

Result ▼

45.2

(19-84)

39.4

(21-76)

38.7

(24-45)

53.6

(35-77)

39.2

(19-72)

48.3

(27-84)

45.9

(19-84)

Cervical (Cx) Squamous Neoplasia

20

(19.6%)

14

(34.1%)

26

(92.9%)

1

(1.0%)

46

(35.1%)

44

(16.9%)

151

(22.8%)

Cx Squamous Carcinoma

1

(3.9%)

1

(0.2%)

CIN2/ 3

3*

(2.9%)

3*

(7.3%)

17**

(60.7%)

9*

(6.9%)

9

(3.4%)

41***

(6.2%)

CIN1

17

(16.7%)

11

(26.8%)

8

(28.6%)

1

(1.0%)

37

(28.2%)

35

(13.4%)

109

(16.5%)

Cx Glandular Neoplasia

1

(1.0%)

3

(7.3%)

5

(17.9%)

0

8

(6.1%)

4

(1.5%)

21

(3.2%)

AIS

1*

(1.0%)

2*

(4.9%)

5**

(17.9%)

5*

(3.8%)

3

(1.2%)

16***

(2.4%)

Cervical Adenocarcinoma

3

(2.3)

1

(0.4%)

4

(0.6%)

Cervical Adenosquamous Carcinoma

1

(2.4%)

1

(0.2)

Endometrial (EM) Neoplasia

6

(5.9%)

0

1

(3.6%)

28

(28.3%)

1

(0.8%)

18

(6.9%)

54

(8.2%)

Endometrial Adenocarcinoma

3

(2.9%)

1

(3.6%)

16

(16.2%)

14

(5.4%)

34

(5.1%)

Atypical Endometrial Hyperplasia

6

(6.1%)

1

(0.8%)

1

(0.4%)

8

(1.2%)

Complex Em Hyperplasia without atypia

2

(2.0%)

4

(4.0%)

1

(0.4%)

7

(1.1%)

Simple Em Hyperplasia without atypia

1

(1.0%)

2

(2.0%)

2

(0.8%)

5

(0.6%)

Ovarian Neoplasia

1

(1.0)

0

1

(1.0%)

1

(0.8%)

1

(0.4%)

4

(0.6%)

Ovarian Serous Adenocarcinoma

1

(1.0%)

1

(0.8%)

1

(0.4%)

3

(0.5%)

Ovarian Clear Cell Carcinoma

1

(1.0%)

1

(0.2%)

Total

27

(26.5%)

16*

(39.0%)

27**

(96.4%)

30

(30.3%)

55*

(42.0%)

67

(25.7%)

222***

(33.5%)

*1 with AIS and CIN2/3 **5 with AIS and CIN2/3 *** 8 with both AIS and CIN2,3

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33 楼发表于2009-06-12 22:03:00举报|引用
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本帖最后由于 2009-06-14 12:51:00 编辑 Gynecol Oncol. 2009 Jun 6. [Epub ahead of print]

Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: Results from a large academic womens hospital laboratory employing sensitive screening methods.

Zhao C, Florea A, Onisko A, Austin RM.

Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213-3180, USA.

OBJECTIVE: Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS: AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS: Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS: AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.

宫颈涂片发现不典型腺细胞的662例病人的组织学随访：结果来源于应用敏感筛查方法的一大型妇产教学医院

目的：宫颈涂片中发现的不典型腺细胞(AGC)的解释及其对腺体肿瘤的筛查作用是目前存在的难点，因此我们对大量的AGC病例进行了组织学随访并对实验室筛查结果的灵敏性进行了误差校对（verification bias-adjusted ？）。

方法：将宫颈涂片中的AGC-EC(不典型腺细胞-来源于宫颈)，AGC-EM(不典型腺细胞-来源于子宫内膜)，AGC-NOS(不典型腺细胞-来源不明确)列入统计范围，数据来源于主要服务对象是老年低危人群的一医疗中心。98%的宫颈涂片使用的是液基细胞学计算机辅助筛查系统，根据细胞学结果又将随访诊断结果和年龄进行了分组。根据一年后组织学诊断结果对筛查的灵敏性进行了评估，根据超过2000例子宫切除病人的结果进了误差校对（Verification bias was adjusted with findings in over 2000 patients with hysterectomies？）

结果：在247,131例宫颈涂片中，1021 (0.41%)例报告了AGC，对其中的662例进行了组织学随访，发现癌前病变和恶性肿瘤病人101(15.3%)例，其中宫颈占 8.3%,子宫内膜占 6.3% ,卵巢占0.6%. 年龄小于40岁者发现的AGC多与宫颈肿瘤相关，年龄大于等于50岁者发现的AGC多与子宫内膜肿瘤相关，AGC-NOS伴有磷状上皮异常或AGC-EC多提示宫颈肿瘤，而AGC-EM多提示子宫内膜肿瘤。

结论：宫颈涂片发现AGC的病人中有相当部份病人有宫颈或非宫颈的肿瘤。在非典型腺细胞中随访中确认为癌的44例病人中38例(86%)属于子宫内膜癌或卵巢癌，因此宫颈涂片发现AGC随后的HPV基因检测对于发现大多数的恶性肿瘤来说并无帮助。该实验室对宫颈肿瘤检测经过误差校对后的灵敏性是93%。（Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.）

(laurelshihxbl 翻译，注：红色部份翻译是否确切，请赵老师和诸位指点，主要是对verification bias-adjusted的中文不太熟悉)

Gynecol Oncol. 2009 Jun 6. [Epub ahead of print]

Histologic follow-up results in 662 patients with Pap test findings of atypical glandular cells: Results from a large academic womens hospital laboratory employing sensitive screening methods.

Zhao C, Florea A, Onisko A, Austin RM.

Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213-3180, USA.

OBJECTIVE: Atypical glandular cell (AGC) Pap interpretations and screening for glandular neoplasias remain major challenges. We document the largest reported AGC histopathologic follow-up experience and include verification bias-adjusted data on laboratory screening sensitivity. METHODS: AGC Pap tests of endocervical origin (AGC-EC), endometrial origin (AGC-EM), and not otherwise specified (AGC-NOS) were documented at a center serving an older low risk population. 98% of Pap tests were liquid-based cytology (LBC) specimens screened using computer-assisted screening. Follow-up diagnoses were correlated with cytology and stratified into age groups. Screening sensitivity was assessed by examining Pap results during 1 year preceding neoplastic diagnoses. Verification bias was adjusted with findings in over 2000 patients with hysterectomies. RESULTS: Of 247,131 Pap tests, 1021 (0.41%) reported AGC results and 662 cases had tissue follow-up. Precancerous or malignant neoplastic histologic outcomes were documented in 101 patients (15.3%), including 8.3% cervical, 6.3% endometrial, and 0.6% ovarian. AGC results were most often associated with neoplastic cervical outcomes in women younger than 40 and with neoplastic endometrial outcomes in women 50 or older. AGC-NOS with a squamous cell abnormality and AGC-EC results suggested cervical neoplasia, while AGC-EM results suggested endometrial neoplasia. CONCLUSIONS: AGC Pap results detected significant numbers of cervical and non-cervical neoplasias. Since 38 of 44 (86%) of AGC-detected carcinomas were endometrial or ovarian, HPV co-testing would not have aided screening in detecting the majority of malignancies diagnosed after AGC Pap results. Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.

宫颈涂片发现不典型腺细胞的662例病人的组织学随访：结果来源于应用敏感筛查方法的一大型妇产教学医院

目的：宫颈涂片中发现的不典型腺细胞(AGC)的解释及其对腺体肿瘤的筛查作用是目前存在的难点，因此我们对大量的AGC病例进行了组织学随访并对实验室筛查结果的灵敏性进行了误差校对（verification bias-adjusted ？）。

方法：将宫颈涂片中的AGC-EC(不典型腺细胞-来源于宫颈)，AGC-EM(不典型腺细胞-来源于子宫内膜)，AGC-NOS(不典型腺细胞-来源不明确)列入统计范围，数据来源于主要服务对象是老年低危人群的一医疗中心。98%的宫颈涂片使用的是液基细胞学计算机辅助筛查系统，根据细胞学结果又将随访诊断结果和年龄进行了分组。根据一年后组织学诊断结果对筛查的灵敏性进行了评估，根据超过2000例子宫切除病人的结果进了误差校对（Verification bias was adjusted with findings in over 2000 patients with hysterectomies？）

结果：在247,131例宫颈涂片中，1021 (0.41%)例报告了AGC，对其中的662例进行了组织学随访，发现癌前病变和恶性肿瘤病人101(15.3%)例，其中宫颈占 8.3%,子宫内膜占 6.3% ,卵巢占0.6%. 年龄小于40岁者发现的AGC多与宫颈肿瘤相关，年龄大于等于50岁者发现的AGC多与子宫内膜肿瘤相关，AGC-NOS伴有磷状上皮异常或AGC-EC多提示宫颈肿瘤，而AGC-EM多提示子宫内膜肿瘤。

结论：宫颈涂片发现AGC的病人中有相当部份病人有宫颈或非宫颈的肿瘤。在非典型腺细胞中随访中确认为癌的44例病人中38例(86%)属于子宫内膜癌或卵巢癌，因此宫颈涂片发现AGC随后的HPV基因检测对于发现大多数的恶性肿瘤来说并无帮助。该实验室对宫颈肿瘤检测经过误差校对后的灵敏性是93%。（Verification bias-adjusted Pap screening sensitivity in the laboratory for detection of significant neoplastic cervical disease was 93%.）

(laurelshihxbl 翻译，注：红色部份翻译是否确切，请赵老师和诸位指点，主要是对verification bias-adjusted的中文不太熟悉)

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