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Κυτταρολογία τραχήλου της μήτρας

Δυνητικά ψευδώς αρνητικά

?? ??????????? ??????????? ????? ????? ????????????? ????? HSIL, ??? ??? ?? ??????????? ??? ?? ???????????? ????? ????????????? ?? ??????.  

?????????? ??? ????? ??????? ??????, ???? ????? ?????? ????????? in situ ???? ?? ??????? ?????? ?? ????? ?????????????? ????? ??? ??????? ?? ????? ???? ?????????? ??? ??? ????????????. ??????? ??? ???? ??? ????????? ?????????? ??? ?? ????????? ?? ???????????? ????? ? ????? HSIL ????? ??? ???? ???????? ???? ???? ??????? ??????? ???? ??? ??? ???????? ?????????? ???????, ??? ????? ?? ???? ??? ????????.

 

????? 10.1 (a) HSIL ?? ????? ???????
????? 10.1 (b) ?????????? ??????? ???????

 

???????????? (Pale) ?????????? ?? ??? HSIL ??????? ?????????????? ??? ????????????, ? ??????? ?????? ?? ????? ?????????????, ??????????? ??????? ?? ???????? ??? ??????? ??????? ????????? – ? ??? ????????????? ??????? ???? ?? ??????? ????? ??????.

 

Figure 10.2 (a) Pale cell dyskaryosis (moderate).  This was correctly reported as moderate dyskaryosis and confirmed as CIN2 but would have justified an ASC-H report if these were representative of the abnormal cells or the only ones present.  Nuclear chromatin and nuclear membrane irregularity are only mildly abnormal in this case and NC ratio around 50% in most cells.
(b) Large pale cell HSIL (CIN3).  This appearance may be difficult to interpret because the friable cytoplasm is largely lost making NC ratio impossible to assess.  The nature of the cells can be determined from the abnormal chromatin pattern, disorderly arrangement of cells, variable cell size and density of nuclear staining.  This appearance is most often seen in CIN3 rather than CIN2.

 

HSIL ?? ????? ??? ???????????? ??????? ???? ???????????? ??? ???????? ????????????? ??? ?????????????? ?? ???????????? ??? ???? Smith & Turnbull (1997)

 

?????????????? ??????????? ?????????? ??????

???????????? ? ?????????????? ??????????? ?????????? ?????? HSIL ? ????? ??? ???????? ?????? ?? ??????????? ???? ????????? ?????? ? ?? ?????????????? ???? ??? ?????????? (review). ???? ?? ??????? ?????? ?? ????????? ??????? ??? ???????????, ??????? ???????? ??? ?? ???????? ????? ??? ?????? ? ?????? ?????????????? ???????? ?? ????????????? ??????????.

????? 10.3 (a-c) ?????????????? ??????????? ?????????? ??????

Figure 10.3. a) An example of what has been described as ‘bland dyskaryosis’ and is reproduced from Figure 10 in Denton et al. 2008. The key to its recognition is the disorderly arrangement of cells in the group and the high NC ratio of cells that otherwise have some resemblance to endocervical cells. 
Figure 10.3.b) HSIL in this case from the BSCC Terminology Conference is only recognisable from separated cells at the margin of the cell group. 
Figure 10.3.c) This group of cells superficially looks like a cluster of benign endomtrial cells and has already been shown in Chapter 9c as an example of a problematic hyperchromatic crowded group of cells that could justify an ASC-H report.

 

???? ?? ???????????? ??? ?????????????? ?????????? ?????????? ?????? HSIL ?????????????? ?? CIN3. ????? ?????? ??? ?? ????? ??????? ?? ???????????? ?? ????????? ??????? ?? ?? BSCC ?????????????? ????????? ??? Denton et al. 2008.

‘?????????? ???????????’

??????????? HSIL ? ????? ??? ???????? ?? ??-?????? ???????? ?????? ?? ???????? ?????????? ????????? ??? ????????. ??????? ???? ????????? ??????????? ?? ??????? ?????????? ?????????? ??? ?? ????????? ????? ?? ??????????? ??????. 

 

????? 10.4 HSIL+?? ?????? ????????.

 

?????????????? ?????????? ?? ??????? ??? ?????? ???????? ????????????

????????? ??????????? ????? ?????? ??? ????? ?? ??????? ??? ?????? ???????? ???????????? ??? ?? ??????? ????? ?????, ???????????? ??? ???? ?? ?????? (Mitchell & Medley 1995; Demay 1996)  ??? ??? ??  ‘????????????’ ????????????? ???? ????????? ?????? (Robertson & Woodend 1993; Demay 2000).  ???????? ???????? ????? ????????? ??? ???? ???????????? ????? ????? ?? ?? ????? ThinPrep (Leung et al. 2008).

????????????/ ?????????????? ??????????? ?????????? ?????? ??? ???? ??????? ??????? ??????? ?????? ??? ????? ?? ?????????? ?????? ??? ?????? ???????? ??? ???????? ?????? ???????? ???????????? ?? ??? ????? SurePath (Gupta et al.2013).

 

Cytological changes at risk for false negative reports in   conventional and LBC slides

  • Conventional smears have been shown to be at risk for false negative reports if the cells are small, pale or few in number (Mitchell & Medley 1995; Demay 1996)
  • ‘Microbiopsies’ may be overlooked at primary screening (Robertson & Woodend 1993; Demay 2000).  Similar findings have been reported for liquid-based cytology using ThinPrep (Leung et al. 2008).
  • Sparse abnormal cells and microbiopsies/hyperchromatic crowded cell groups were found to be the commonest reasons for false negative and potential false negative cytology using SurePath (Gupta et al. 2013).

 

How to avoid false negative results

  • Careful examination of the whole slide
  • Familiarity with the main causes of false negatives
  • Attention to nuclear changes of dyskaryosis
  • Training, update and quality control
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