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非典型腺细胞 AGCUS

孙晓光
孙晓光主任医师 副教授北京协和医院 妇科
患者 :病情描述(发病时间、主要症状、就诊医院等): 上周的 体检 结果说有 非典 型腺细跑:AGC-NOS, 请问为癌前病变的几率大么?我该怎么办? 北京协和医院妇科孙晓光
北京协和医院妇科孙晓光

 

尽管人群中只有0.2%出现AGC,但此类人群的38%有鳞状上皮或腺上皮的病变。

 

如果你的年龄超过30岁, 你需要做的事:

1 HPV定量测定。

2 阴道镜加宫颈多点活检和宫颈管取样。

3 B超检查子宫内膜的厚度, 结合家族史确定有无必要行子宫诊刮。

 

如果你检查了上述, 没有发现病变, 但是HPV是阳性的, 你需要:每半年复查TCT和HPV。如果HPV是阴性的, 你需要每年复查TCT和HPV。

 

原文出自美国阴道镜和宫颈病理协会:2006年关于AGCUS的处理指南

ATYPICAL GLANDULAR CELLS

Only 0.2 percent of cytologic smears exhibit atypical glandular cells (AGC). 19 Although benign lesions are the most common underlying cause, AGC can indicate a significant squamous or glandular lesion up to 38 percent of the time. 27 Because CIN is the most common pathology, especially for women younger than 35 years, 28 initial evaluation includes colposcopy with endocervical sampling and HPV DNA testing for all subcategories of AGC and AIS. 5 , 6 Endometrial sampling is also recommended in women 35 years and older or in younger women with risk factors for endometrial cancer. 5 , 6 Reflex HPV DNA testing or repeat cytology is unacceptable as initial triage of atypical glandular cells–not otherwise specified (AGC-NOS), AGC–favor neoplasia, or adenocarcinoma in situ (AIS). 5 , 6

HPV positivity has a high positive predictive value for significant cervical disease, with 20 percent of women having CIN 3 or cancer on biopsy. 29 If the initial evaluation of AGC is unremarkable, cytology and HPV testing should be repeated in six months if HPV testing is positive, and at 12 months if HPV testing is negative. 5 , 6 If HPV testing and cytology are both negative on reevaluation, annual cytologic testing may resume. 5 , 6 If HPV DNA status is unknown, retesting at six-month intervals for a total of 24 months is recommended 5 , 6 ( Figure 5 6 ). If initial cytology is AGC–favor neoplasia or AIS instead of AGC-NOS, an excisional procedure may be required for full evaluation despite initial negative testing 5 , 6 ( Figure 5 6 ).



 

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发布时间:2011-06-01 18:07

孙晓光主任医师 副教授
北京协和医院 妇科
擅长:宫颈癌前病变、反复流产、不孕症、保胎,妇科其他疑难杂症、

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