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- 50岁，宫颈液基
Seldom to read the Pap cases here. Most cases did not have histologic follow-up. People can say what they want to say. There would be no final conclusion. From study point it is not very useful.
Several clusters of cells show increased N/C ratio with prominent and irregular nuclei. At least I will call AGC or AGC-FN. Women should have endocervical and endometrial samplings. I once showed one case which looks like reactive change, but turned out to be an endocervical ca. I feel 白浪费了时间，很少朋友从这些病例中学习到了教训。
Priniciple: Pap test is a screening test. Several largest studies demonstrated that 70-80% women with AGC Pap turned out to be benign after endocervical or endometrial samplings. It can be repair or reactive change for above case. My question is that who can say definitely it is not a neoplastic lesion in this 50 year women. If we call AGC or AGC-FN and the final histologic finding is benign, it is fine (standard care).
If you call benign Pap and finally the women has carcinoma, what will you do?
Do not try hard to require all your cases of AGC Paps to be glandular neoplasams in histologic follow-up. If it is true that 100% of your agc cases are cervical or glandular neoplasms in histology in your practice. I can say you have missed many glandular lesions in your Pap evaluation.
| 以下是引用cqzhao在2010-6-1 11:02:00的发言：
Strongly support. But you change your oppinion after you looked more casrefully.Why? |
谢谢赵老师！有你的点评，这样的病例又有了生命。谢谢！！
我没有改变我的看法。
对每一个病例，初步分析是必要的，但除了初步分析外，还必须要有一个整体印象的。
这个病例给我的整体印象有三个：
（1）不能用修复、化生等反应性改变来对这样的病例进行轻易的判定。这点非常肯定。（2）腺上皮是有问题的——AGC，非典型宫颈内膜细胞。这点也很肯定。
（3）是反应性改变？还是肿瘤性改变呢？这是难点，是我存在疑问的地方。这是不肯定的部分。
我后面对其它视野的分析和对其他老师的回复仅是例行分析而已，每一个病例都是有重点的，抓住重点就抓住了本质。我认为这个视野才是整个病例的核心。
