[Abstract] Objective reveal cervical liquid-based cytology (LBC) the accuracy of diagnosis of adenocarcinoma of the female reproductive system. Methods Cancer Hospital of Chinese Academy of Medical Sciences from 2001 to 2005 histological diagnosis of adenocarcinoma of the female reproductive system and its LBC diagnostic control, at the same time to select the same period in cervical LBC diagnosis adenocarcinoma cells (AdcaC), suspicious adenocarcinoma cells (Sus  AdcaC) were and SARS glandular cells (AGC) control their histological diagnosis, the Sus  AdcaC LBC diagnosis as the starting point, the histological diagnosis as the gold standard, statistical analysis of data. Results A total of 259 cases included in the analysis. Cervical LBC diagnosis of adenocarcinoma of the female reproductive system sensitivity 42.6%, specificity 91.5%, positive predictive value and negative predictive value of 93.0% and 37.6%, respectively; cervical adenocarcinoma, endometrial adenocarcinoma and ovarian The sensitivity of the fallopian tube adenocarcinoma were 65.6%, 38.9% and 36.1%, respectively, the former being significantly higher than the latter two (P = 0.016). Cervix LBC diagnosis of adenocarcinoma of the reproductive system sensitivity to its clinical pathological stage (P = 0.001), and also tended to increase with the increase the diagnostic sensitivity of the clinical and pathological staging. Conclusion cervical LBC diagnosis helps to improve the sensitivity of the diagnosis of adenocarcinoma of the female reproductive system, but there are some limitations.

Key words】 cervical liquid-based cytology; female reproductive system; adenocarcinoma

Analysis of Diagnostic Accuracy for Adenocarcinoma of Female Genital System by Cervical Liquid  based Cytology

    ZHAO Huan, WANG Nai  peng, ZHAO Lin  lin, CAO Jian, PAN Qin  jing

    Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China

    Corresponding Author: PAN Qin  jing, E  mail: pqjing@hotmail.comAbstract: Objective To explore the diagnostic accuracy for adenocarcinoma of female genital system by cervical liquid  based cytology (LBC). Methods The cases with adenocarcinoma of female genital system were selected to find their cervical LBC diagnoses, meanwhile, the cases with the diagnoses of adenocarcinoma cells (AdcaC), suspicious adenocarcinoma cells (Sus  AdcaC) and atypical glandular cells (AGC) by cervical LBC were selected to find their histological diagnoses. These cases were all from Cancer Hospital Chinese Academy of Medical Sciences during 2001 to 2005. The diagnoses of histology were taken as golden standard and Sus  AdcaC was taken as a cut point of LBC diagnoses to analyze the accuracy of LBC diagnoses. The data were analyzed by SPSS 13.0 software.Results A total of 259 cases was selected. The sensitivity and specificity of cervical LBC diagnoses for adenocarcinoma of the female genital system were 42.6% and 91.5%, respectively; the positive prognostic value and negative prognostic value were 93.0% and 37.6 %, respectively. The sensitivities of cervical LBC diagnoses for endocervical adenocarcinoma, endometrial adenocarcinoma and ovarian / fallopian tubal adenocarcinoma were 65.6%, 38.9% and 36.1%, respectively. The sensitivity for endocervical adenocarcinoma was higher than that for endometrial adenocarcinoma and fallopian tubal adenocarcinoma significantly (P = 0.02). The diagnostic sensitivity of cervical LBC had a trend of increase as the increase of clinicopathological stages (P = 0.001). Conclusion Cervical LBC is helpful for increasing the diagnostic sensitivity of female genital system adenocarcinoma, but it has certain limitations.

    Key words: Cervical LBC; Female genital system; Adenocarcinoma

    Cervical liquid-based cytology (liquid  based cytology, LBC) that had been initiated more than 10 years, there are a large number of reported accuracy of LBC screening of cervical squamous cell carcinoma, but their reported screening adenocarcinoma accuracy even less. In this study, a retrospective study, histopathological diagnosis standard, reveal cervix LBC accuracy of the diagnosis of adenocarcinoma of the female reproductive system.

    1 Materials and methods

    1.1 Materials

    Select Cancer Hospital of Chinese Academy of Medical Sciences from 2001 to 2005, control of the biopsy and (or) the surgical removal of the histological diagnosis of the female reproductive system adenocarcinoma and its the LBC diagnostic results and select the same period in the glandular cells of the cervix LBC diagnosis unusual cases to their histological diagnosis results control . Selected cases of LBC smears are made by ThinPrep2000 (Cytyc Corp. USA).

    1.2 LBC diagnosis

    LBC diagnostic criteria the cervical cytology the TBS diagnostic system [1], but suspicious abnormal diagnostic classification of glandular cells in addition to atypical glandular cells (atypia of glandular cells, AGC) and adenocarcinoma cells (adenocarcinoma cells, AdcaC) outer join adenocarcinoma cells (suspicious adenocarcinoma cells, Sus  AdcaC). The Sus  AdcaC cells have the characteristics of the glandular cells and cancer cells, but in the quantity or quality enough to diagnose AdcaC.

    1.3 statistical methods

    The entry point for the diagnosis of cervical LBC for Sus  AdcaC, histological diagnosis standard count. Χ2 test significant differences among the groups was used to compare the correlation between LBC diagnostic results and clinical pathological stage using Spearman rank correlation analysis, data SPSS13.0 statistical software, P <0.05 for the difference was statistically significant.

    2 Results

    2.1 Case type and age distribution

    The histologic diagnosis LBC and LBC and histological specimens were satisfied by 259 cases, including 188 cases of histological diagnosis of adenocarcinoma the the (sub carotid adenocarcinoma 32 cases, 95 cases of adenocarcinoma in the endometrium, ovary and fallopian tube adenocarcinoma 61 cases, no cases of vaginal adenocarcinoma). Sub-neck cancer, endometrial adenocarcinoma, and the minimum age of the ovary and fallopian tube adenocarcinoma patients were 30, 31 and 36 years old, the maximum aged 76,83 and 73 years old, with a median age were 51, 55 and 52 years old, three was no significant difference (P = 0.19).

    2.2 LBC diagnostic accuracy

    2.2.1 LBC diagnosis and histological diagnosis of control

    Diagnosis of 60 cases in 188 patients with adenocarcinoma of the histological diagnosis, LBC AdcaC the 20 patients Sus  AdcaC, 32 cases of AGC, 7 cases of abnormal squamous cells, four cases of atypical squamous cells  significance clear the (ASC  U.S.), cases of atypical squamous cells  except grade squamous intraepithelial lesions (ASC  H), 2 cases low-grade squamous intraepithelial lesions (LSIL) and 69 cases no intraepithelial lesions or malignant cells (NILM). LBC diagnosis AdcaC, Sus  AdcaC and AGC total of 183 cases, the histological diagnosis of 92 cases of adenocarcinoma, 4 cases of squamous cell carcinoma, 19 cases of squamous intraepithelial lesions and 48 benign lesions. Diagnosis and histological diagnosis of cervical LBC control, as shown in Table 1. Table 1 cervical LBC diagnosis and histological diagnosis control

2.2.2 cervical LBC accuracy of the diagnosis of adenocarcinoma of the female reproductive system

    Cervical LBC the Sus  AdcaC diagnosis as the starting point, LBC diagnosis of adenocarcinoma of the female reproductive system sensitivity was 42.6% (80/188), and a specificity of 91.5% (65/71), positive predictive value and negative predictive value 93.0% (80/86) and 37.6% (65/173), respectively. Adenocarcinoma of the cervix, endometrial adenocarcinoma and sensitivity of the diagnosis of ovarian fallopian tube adenocarcinoma were 65.6% (21/32), 38.9% (37/95) and 36.1% (22/61), in which the cervix adenocarcinoma of the highest diagnostic sensitivity (χ 2 = 8.31, P = 0.02).

    2.3 cytological diagnosis results with clinical pathological stage relationship

    116 cases of adenocarcinoma of the clinical and pathological staging data increasing trend with increasing clinical and pathological staging, the detection rate of cervical LBC adenocarcinoma of the female reproductive system, as shown in Table 2. Table 2 cytologic diagnosis of adenocarcinoma of the female reproductive system

3 Discussion

    Pap smear cytology is an effective method of screening for cervical squamous cell carcinoma, but not a good tool for screening for lesions of the glandular cells. Cervical adenocarcinoma usually occurs at the the cervical squamous columnar junction of the glandular epithelium, glands than the surface of deep glands susceptible to involvement, and the lesions can be very limited, especially adenocarcinoma in situ. Change with age, the transition zone back into the cervical canal is more difficult to check the gland cells in lesions through the Ministry of cervicovaginal smears, cytologic diagnosis of the problem may be due to less glandular cells. The reported conventional Pap smear diagnosis of cervical adenocarcinoma false negative rate of 50% [2]. The study of cervical LBC cervical brush drawn than the conventional Pap smear, cervical scraper or double extractor based easy depth cervical canal, and easy to get glandular cells. Howlett et al [3] reported that Lake Ontario region the incidence of cervical adenocarcinoma in the late 1990s, in the application of the cervix brush drawn down rate of 4% per year improvement derived get fuller specimens, improve the diagnostic rate.

    Cervical LBC diagnosis of endometrial adenocarcinoma and ovarian tubal adenocarcinoma is indirectly derived, to be dependent on the adenocarcinoma cells off the cervix. It has been reported vaginal fornix is ​​found the main parts of the endometrial cells than conventional cervical smears found more than 1/3 of the hidden endometrial cancer [2]. The suspected of endometrial lesions other than those the conventional cervical drawn outside should increase the posterior fornix drawn. Well-differentiated endometrial adenocarcinoma cells is difficult with normal or hyperplastic endometrial cells distinction. Endometrial cells seen in the women’s cervical smear should report a high incidence of endometrial cancer age group (40 years and older) in cervical cytology diagnosis TBS system requirements. Shedding endometrial cells, ovarian and fallopian tube cells often occurs degeneration affect cytologic diagnosis. LBC producer wet specimens fixed, reducing the cell degeneration, and increases the cell structure of clarity. Studies have demonstrated the ThinPrep LBC screening detection rate of endometrial adenocarcinoma (0.05%) than the conventional Pap smear detection rate (0.01%) [4], to a certain extent, LBC increase diagnostic sensitivity.

    This study shows that the detection rate of cervical LBC adenocarcinoma of the female reproductive system, with its clinical and pathological staging, with clinicopathological stage increased, the detection rate increased. The diagnosis of adenocarcinoma of the female reproductive system, reported in the literature of cervical cytology sensitivity will be different because of the reported cases of composition different from [5-].