Home » Courses » Κυτταρολογία τραχήλου της μήτρας » 10. Παγίδες στην κυτταρολογία του τραχήλου » Αποφυγή υπερ-διάγνωσης άτυπης/οριακής κυτταρολογίας

Κυτταρολογία τραχήλου της μήτρας

Αποφυγή υπερ-διάγνωσης άτυπης/οριακής κυτταρολογίας

??????? ????-????????? ??????/??????? ?????????????

????? ??????? ??????? ?? ???????????? ???????? (ASC-US)

  • ASC-US (? ??????? ?????????? ?? ??????? ???????) “??????????” ?? LSIL ??? ?????? ?? ????? ?? ?????? ????? ?? ??? HPV ???????. 
  • HPV ???????????? ??????? ????????? ????????? ?????????? ?? ????? ? ??????? ??????? ??????? ????? ?????????????? (?? ???????? ??????????? ?????????????? ??? HPV ????????). 
  • ???????? ???????? ????????? ??? ???????????? ????? ????? ?? ????-??????????????? ???????? ??? ?????? ?????? ?? ??????????????? ?? ASC-US. 
  • ????????? ?????????? HPV, ?????????????? ?? ??????-???????? HPV ???????, ?? ?????? ?? ?????????????? ?? ?????????? ??? ????????? ??? ????????? LSIL.

 

????? 10.9 ???????????? ASC-US ??? “???????????” ?? ??????????? ?????????? ??? LSIL

(a) ASC-US ‘??? ??????????’ ?? ??????????? ??????????. (b) ???????? ?????????????? HPV.  (c) ASC-US ?? ?????????????? HPV ?? ?? ???? ?? ??????????? ??????? ?? ????????? CIN3.

????? 10.9 ???????????? ASC-US ??? “???????????” ?? ??????????? ?????????? ??? LSIL

 

(a) ASC-US ‘??? ??????????’ ?? ??????????? ??????????
(b) ???????? ?????????????? HPV
(c) ASC-US ?? ?????????????? HPV ?? ?? ???? ?? ??????????? ??????? ?? ????????? CIN3

 

????? ??????? ???????, ??? ??? ?????????? HSIL (ASC-H)

ASC-H ?????????? ???? ?????????????? HSIL ??? ????? ?????? ??????????? ????? ??? ??? ??????????? ???????????? ?? ???????? ?????? ???????? ??? ?????? ??????. 

?????? ?????? ??????? ??? ?? ??????? 10.1 (b), 10.2 (a-b), 10.3 (a-c) ??? 10.6 (b ??? c) ?? ????????? ?? ??????????? ?? ?SC-H ??? ???? ???? ???????????????? ??? ???????????? ?? ???????????? ???????? ??? ????????. ???? ??????????????, ?????? ??? ???? ???????????? ?? ASC-H. 

???????????, ?????? ???????????? ???????? ????????? ?????????? ??? ?????????? ?????????? ?? ???? ??????? ???? ?????????? ???????? ?? ????????? ??? ASC-US ?????????? – ???? ???????? ??? ????? 10.7 (c ??? d).

? ????????? ??? ???????? ??? ??????????? ??????? ?????????????? HSIL ???????? ?? ?????? ???????? ASC-H ????????????? 

 

????? ??????? ??????? (AGC)

AGC ???????????? ??? ????? ????????:

  1. ???????? ???????? ? ????????????? ??????????? ??? ????????????? ??????? ??????? ???? ???????? ??? ????? 10.7 (a-c)
  2. ???????? ????????????? ???????? ???????? ??? HSIL ???? ???????? ??? ????? 10.5 (e).

???????? ?????????????? AIS ?????? ?? ?????????????????? ??? ???????????? ????????????? ???????, ???????? ????????? ??? TEM ?? ??? ?????????? ?????????? ??? ????? ??? ??????????, ??????????? ??????? ??? ???????? ??? ??????? ???????? ????????? ? ???????. 

 

Figure 10.10 ????? ??????? ??????? ???? ??????????

(a) ????????? ????????? ??? ???????? AIS ???? ?? ????? ????????? ??? ????? ???????? ????????.
(b) AIS ??? ??????????? ????? ?? ????? ??? ????????? ?????.
(c) AIS ?? SurePath.

 

How to avoid unnecessary ASC-H and AGL reports

  • Search the slide for more obvious HSIL or CGIN before reporting the slide
  • Discuss difficult cases with colleagues before sending out ASC-H or AGL reports
  • Colposcopy and multidisciplinary review of histology and cytology slides can avoid unnecessary treatment in atypical cases
  • Remember that judicious use of ASC-H and AGL categories can avoid false positives and false negatives

 

Learning points from Chapter 10

  1. Dyskaryosis should be present in all false negative and absent in all false positive cellular abnormalities (at least on review)
  2. ASC and AGL (borderline) reports should only be used for genuine doubt between negative/reactive and SIL/neoplasia
  3. False negatives can be avoided by familiarity with their main causes: sparse, pale and small cell dyskaryosis, hyperchromatic crowded cell groups, and dyskaryosis masked by inflammation
  4. Hyperchromatic crowded cell groups and sparse dyskaryotic cells are potential false negatives in LBC as well as conventional smears
  5. False positives may be avoided by familiarity with the full spectrum of reactive changes in metaplastic and inflammatory conditions
  6. Endocervicitis, atrophic vaginitis, immature squamous metaplasia, tubal metaplasia and tuboendometrioid metaplasia are important potential false positives
  7. False positives are important because unnecessary excision biopsy may increase risk of premature rupture of membranes in pregnancy
  8. Atypical/borderline reports when used in cases of genuine doubt may avoid false negatives and false positives

 

X