Background: Squamous intraepithelial lesions observed in Papanicolaou (Pap) test gynecologic cytology arise as a result of infection of the cervicovaginal tract by human papillomavirus (HPV). The viral cytopathic effect of HPV manifests as koilocytosis, also known as low-grade squamous intraepithelial lesion (LSIL) in The Bethesda System (TBS). Integration of HPV genetic material into the genome of squamous cells can, in some women, result in progressive accumulation of mutations and abnormalities of growth and maturation leading to high-grade squamous intraepithelial lesion (HSIL) and possibly invasive squamous cell carcinoma. Due to morphologic overlap between reactive processes and these changes related to HPV, TBS includes equivocal categories that may be applied to Pap tests with uncertain morphology: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude HSIL (ASC-H). Quality assurance (QA) measures in gynecologic cytology laboratories aim to maximize the sensitivity for LSIL and HSIL lesions while simultaneously keeping the use of ASC-US at reasonable levels. Summary: TBS provides a comprehensive nomenclature for squamous abnormalities encountered in screening, but subjectivity in interpretation remains. QA practices attempt to identify problematic patterns of misinterpretation for correction. Key Message: This review aimed to provide practical recommendations for cytology practitioners seeking to alter their interpretive thresholds for ASC-US, LSIL, and HSIL in response to feedback from QA procedures indicating deviation from desired norms.
Acta Cytologica

中文翻译：

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宫颈细胞学鳞状细胞异常的实用方法：解释标准概述和改变阈值以响应质量保证结果的指南

背景：在巴氏 (Pap) 试验妇科细胞学中观察到的鳞状上皮内病变是由人乳头瘤病毒 (HPV) 感染宫颈阴道道引起的。HPV 的病毒性细胞病变效应表现为空洞细胞增多症，在 Bethesda 系统 (TBS) 中也称为低度鳞状上皮内病变 (LSIL)。在一些女性中，HPV 遗传物质整合到鳞状细胞基因组中会导致突变的逐渐积累以及生长和成熟异常，从而导致高度鳞状上皮内病变 (HSIL) 和可能的浸润性鳞状细胞癌。由于反应过程和这些与 HPV 相关的变化之间的形态学重叠，TBS 包括可能适用于具有不确定形态学的巴氏试验的模棱两可的类别：意义未明的非典型鳞状细胞 (ASC-US) 和非典型鳞状细胞不能排除 HSIL (ASC-H)。妇科细胞学实验室的质量保证 (QA) 措施旨在最大限度地提高 LSIL 和 HSIL 病变的敏感性，同时将 ASC-US 的使用保持在合理水平。总结： TBS 为筛查中遇到的鳞状细胞异常提供了一个全面的命名法，但解释中的主观性仍然存在。QA 实践试图识别有问题的误解模式以进行纠正。关键信息：本综述旨在为寻求改变 ASC-US、LSIL 和 HSIL 解释阈值的细胞学从业者提供实用建议，以响应 QA 程序的反馈表明偏离所需规范。
细胞学报