DNA cytometry confirms the utility of the Bethesda System for the classification of Papanicolaou smears
DNA cytometry confirms the utility of the Bethesda System for the classification of Papanicolaou smears
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DOI：
10.1002/cncr.9033.abs
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发表时间：
2001-06-25
影响因子：
3.4
通讯作者：
Bodo, M
中科院分区：
文献类型：
--
作者：
Bollmann, R;Bollmann, M;Bodo, M
背景Bethesda系统于1989年开发，已在很大程度上取代了以前宫颈前巴氏涂片的分类。该系统是二元的，将涂片分为两组-低度鳞状上皮病变（LSIL）或高度鳞状上皮病变（HSIL）。第三类，意义不明的非典型鳞状细胞（ASCUS），用于分类不满足低级别或高级别类别标准的最小细胞变化。本研究的目的是确认这种二进制划分的效用，并与另一个分类系统（慕尼黑II Nomenclature），这不是二元的，但包含三个部门或等级的异型增生-低，中，高。方法，巴氏涂片获得了593名妇女的细胞学诊断的异型增生的基础上慕尼黑系统。然后，Bethesda系统将涂片分类为LSIL或HSIL。患者随访2年，进行活检或重复细胞学检查。通过Feulgen方法对初始涂片进行再染色，并通过交互式DNA细胞仪评估倍性。241例LSIL中二倍体占39%，多倍体占57%，异倍体占4%; 352例HSIL中二倍体占4%，多倍体占17%，异倍体占79%。经过2年的随访，2 108例活检，谁最初被归类为二倍体进展为宫颈上皮内瘤变/原位癌（CIN/CIS），而109 217例异倍体和活检的患者被发现有CINIII/CIS.CONCLUSIONS，两个部门的贝塞斯达系统，LSIL和HSIL，与倍体细胞计数评估。非整倍体被发现是有用的区分HSIL的情况下，从LSIL的定义在贝塞斯达系统。由于二分法，使用三分法的系统治疗发育异常，如慕尼黑II Nominal，造成了治疗困境，因为单一诊断类别（通常为中间等级）可能包含自限性和进行性病变。发现巴氏涂片的DNA细胞术作为常规程序是有用的。癌症（癌症细胞病理学）2001;93：222-228。(C)2001年美国癌症协会。
BACKGROUND. Developed in 1989, the Bethesda System has largely replaced previous classifications of Papanicolaou (Pap) smears front the uterine cervix. The system is binary, dividing smears into two groups - low-grade, squamous, epithelial lesions (LSIL) or high-grade, squamous, epithelial lesions (HSIL). A third category, atypical squamous cells of undetermined significance (ASCUS), is used to classify minimal cellular changes that do not satisfy the criteria for the low- or high-grade categories. This study was designed to confirm the utility of this binary division and to compare the results with another classification system (the Munich II Nomenclature) that is not binary but contains three divisions or grades for dysplasia - low, intermediate, and high.METHODS, Pap smears were obtained from 593 women with a cytologic diagnosis of dysplasia based on the Munich System. Smears were then classified by the Bethesda System into LSIL or HSIL. Patients were followed for 2 years either with biopsy or repeat cytology. The initial smears were restained by the Feulgen method, and ploidy was evaluated by interactive DNA cytometry.RESULTS. Of 241 cases of LSIL, 39% were diploid, 57% polyploid, and 4% aneuploid, Of 352 cases classified HSIL, 4% were diploid, 17% polyploid, and 79% aneuploid. After 2 years of follow-up, 2 of 108 patients who were biopsied and who were originally classified as diploid progressed to cervical intraepithelial neoplasia/ carcinoma in situ (CIN/CIS) whereas 109 of 217 patients who were aneuploid and biopsied were found to have CINIII/CIS.CONCLUSIONS, The two divisions of the Bethesda System, LSIL and HSIL, correlated with ploidy as evaluated by cytometry. Aneuploidy was found to be useful to separate cases of HSIL from those of LSIL as defined in the Bethesda System. Because of the binary division, use of a system with three divisions for dysplasia, such as the Munich II Nomenclature, creates a therapeutic dilemma because a single diagnostic category (usually the intermediate grade) may contain both self-limiting and progressive lesions. DNA cytometry of Pap smears was found to be useful as a routine procedure. Cancer (Cancer Cytopathol) 2001;93:222-228. (C) 2001 American Cancer Society.