The Bethesda System (TBS) - 자궁경부 세포진 검사의 새로운 보고양식 -

김희숙,Kim, Hy-Sook 대한세포병리학회 1995 대한세포병리학회지 Vol.6 No.2

In 1989, the Bethesda System (TBS) was introduced as an attempt to standardize cervical/vaginal reporting systems. TBS nomenclature was created for reporting cytologic diagnoses to replace the currently used Cervical Intraepithelial Neoplasia (CIN) and Papanicolaou Class System, which are deemed less reproducible. The name for preinvasive squamous lesions was changed to squamous intraepithelial lesion(SIL), subdivided into low-grade and high-grade types. TBS recommends a specific format for cytologic report, starling with explicit statement on the adequacy of the specimen, followed by general categorization and descriptive diagnosis. Pathologic and epidemiologic studios performed over last 10 years have provided evidence that human papillomavirus (HPV) plays a significant role in the development of cervical neoplasia, TBS corresponds not only to currently held views of the behavior of preinvasive lesions and their HPV distribution, but also to the current guidelines for clinical management.

자궁경수술로 성공적으로 치료된 점막하 낭성자궁선근종 2예

김남숙 ( Nam Sook Kim ),김주명 ( Joo Myung Kim ),김미라 ( Mi La Kim ),이시원 ( Si Won Lee ),주관영 ( Kwan Young Joo ),김혜선 ( Hye Sun Kim ),김희숙 ( Hy Sook Kim ),홍성란 ( Sung Ran Hong ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.2

Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.

질의 원발성 무색소성 악성흑색종의 세포학적 소견 - 1례 보고 -

홍성란,김희숙,박종택,Hong, Sung-Ran,Kim, Hy-Sook,Park, Chong-Tack 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.1

A case of primary amelanotic melanoma of the vagina diagnosed in scraping smear is described. A 64-year-old woman complained of vaginal bleeding with a $2.5\times2cm$ sized, fungating mass on the right lateral vaginal wall near the introitus for 2 months. Scraping smears from the mass showed scattered individual tumor cells with single, bi- or multi-nucleated eccentric nuclei having prominent macrouucleoli and occasional intranuclear inclusions. The cytoplasm was plump and cyanophilic with a indistinct rim. No melanin pigment was identified. Characteristic cytologic features of this case were very helpful to exclude more common squamous cell carcinoma in the vagina, which was strongly suggested in biopsy specimen.

Papanicolaou smear에서 자궁내막암의 세포학적 진단의 의의 : 조직유형, 분화도 및 병기와의 관련성

홍성란,김희숙,박종숙,Hong, Sung-Ran,Kim, Hy-Sook,Park, Jong-Sook 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

The cytologic detection of endometrial carcinoma in Papanicolaou(Pap) smear according to histologic type, grade and stage was studied in 49 patients. The smears of patients who had histologically confirmed were retrospectively evaluated by the Bethesda System. The cytologic diagnosis of endometrial carcinoma was made in 61% (39/49) of patients, atypical glandular cells of undetermined significance (AGCUS) in 16% (8/49) and within normal limits in 23% (11/49). The positive rate for AGCUS and carcinoma was correlated to the histologic type, grade and stage. The cytologic grade revealed a good correlation with histologic grade, too. In conclusion, the presence of cancer cells in Pap smear suggests the tumor in high grade and high stage. Additionally, cytologic detection of AGCUS or carcinoma needs a further diagnostic evaluation. The Pap smear is a valuable method to screen for endometrial carcinoma.

자궁경부 세포진에서 종양소인의 출현에 대한 분석

조정숙 ( Jung Sook Cho ),박종숙 ( Jong Sook Park ),김희숙 ( Hy Sook Kim ) 대한임상검사과학회 2001 대한임상검사과학회지(KJCLS) Vol.33 No.2

Tumor diathesis is defmed as a host response to tissue destruction by infiltrative growth of cancer. It is observed in smears as eosinophilic or cyanophilic granular proteineous material, Cytoplasmic debris, hemosiderin, fi버11, nuclear fragments and cells with karyorrhexis. The purpose of this study was to determine the prevalence and cytologic features of tumor diathesis in cervicovaginal smears from patients with invasive squamous cell carcinoma. Cervicovaginal smears of 63 patients with squamous cell carcinoma histologically confmned were reviewed to evaluate the presence of macro/micro tumor diathesis(MaTD/MiTD). Original cytologic diagnoses were HSIL with carcinoma in situ in 21 cases(33.3%), microinvasive carcinoma in 13 cases(20.6%) and invasive carcinoma in 29 cases(46%). Tumor diathesis was posItive in 49 cases(77.8%), lltεgative in 10 cases(15.9%) of smears with invasive squamous cell carcinoma and 4 cases(6.3%) were undetermined. Both MaTD and MiTD were seen in 36 cases(73.5%), only MaTD was 9 cases(18.4%) and MiTD was 4 cases(8.2%). As increasing the invasion depth, prevalence of tumor diathesis was increased, but it was not statistically significant(p>O.OO5). Twelves of control group were diagnosed as invasive squamous cell carcinoma cytologically, but they were histologically confmned as carcinoma in situ. Tumor diathesis was positive in 9 cases(75%) of the 12 smears, it was supposed of intraglandular karyorrhetic necrotic material in the glandular involvement with carcinoma in situ. Although tumor diathesis is an important criterion of invasive carcinoma, the smear should be veη carefully searched the presence of invasive carcinoma cells.

Sensitivity of AutoPap Primary Screening System with Location-Guided Screening in Uterine Cervical Cytology

최종순,장회숙,김희숙,전이경,김혜선,박지영,박인서,홍성란,Choi, Jong-Sun,Jang, Hoi-Sook,Kim, Hy-Sook,Chun, Yi-Kyeong,Kim, Hye-Sun,Park, Ji-Young,Park, In-Sou,Hong, Sung-Ran The Korean Society for Cytopathology 2003 대한세포병리학회지 Vol.14 No.2

Objective: The sensitivity of the AutoPap Primary Screening System with Location-Guided Screening (AutoPap LGS) for Identifying atypical cells in cervicovaginal smears was evaluated. Methods: Two hundred forty one slides with atypical cervical cytology randomly sampled were rescreened both manually and by the AutoPap LGS. The AutoPap LGS localized the atypical cells as 15 fields of view(FOVs), which were reexamined by manual review. The sensitivity was also evaluated in accordance with the cellularity of the smears. Results: The AutoPap LGS successfully processed 232 out of 241 slides. The sensitivity of the AutoPap LGS identifying the atypical cells in successfully processed slides was 97.4%(226/232). The false negative rate was 2.6%(6/232). There was no false negative case on high grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma(SCC) smears in the AutoPap LGS. The FOVs localized the diagnostic-atypical cells in 97.8%(221/226). The number of diagnostic-atypical FOVs was increased in higher-degree of atypical cytology. The AutoPap LGS localized the atypical cells in 100% of adequately cellular smears and in 92.5% even in low cellular smears. Conclusion: The AutoPap LGS showed relatively good sensitivity to detect atypical cells. It can be a valuable system to localize atypical cells, especially in HSIL or cancer slides, even in smears with low cellularity.

Bethesda system에 의한 "atypical squamous cells of undertermined significance"의 평가

김의정,홍성란,김희숙,박종숙,김계현,임경호,심재욱,박종택,전종수,Kim, Yee-Jeong,Hong, Sung-Ran,Kim, Hy-Sook,Park, Jong-Sook,Kim, Kye-Hyun,Lim, Kyung-Ho,Shim, Jae-Uk,Park, Chong-Taik,Chun, Chong-Soo 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

The recently proposed Bethesda system for cervical/vaginal cytology has made a standardization related to "atypia". In cellular changes due to inflammation or repair, the word "benign cellular change" has been suggested as a substitute for atypia. Terminology related to atypical cells may become standardized, but the cytologic criteria has not been well defined yet. We evaluated 160 cases of atypical squamous cells of undetermined significance(ASCUS) by the Bethesda Sys4em(TBS). Among 30,428 cases screened, a cytologic diagnosis of ASCUS was made in 498 cases(1.6%) and 160 cases were histologically verified ASCUS was diagnosed based on nuclear enlargement and nonclassical signs of condyloma. The results are as follows: One hundred and twenty three cases(76.9%) revealed chronic cervicitis. Thirty seven cases(23.1%) demonstrated squamous intraepithelial lesion. Among intraepithelial lesions, condyloma and mild dysplasia were 28 cases(75.7%). Moderate and severe dysplasia were 5 cases(13.5%) and 4 cases(10.8%), respectively. it is concluded that patients with ASCUS should be colposcopically examined.

자궁경부세포진에 있어서 AutoPap 300 QC System의 임상경험과 민감도 검사

홍성란,박종숙,장회숙,김의정,김희숙,박종택,박인서,Hong, Sung-Ran,Park, Jong-Sook,Jang, Hoi-Sook,Kim, Yee-Jeong,Kim, Hy-Sook,Park, Chong-Taik,Park, In-Sou 대한세포병리학회 1998 대한세포병리학회지 Vol.9 No.1

OBJECTIVE: False negatives of cervical smears due to screening errors pose a significant and persistent problem. AutoPap 300 QC System, an automated screening device, is designed to rescreen conventionally prepared Pap smears initially screened by cytotechnologists as normal. Clinical experience and sensitivity of the AutoPap 300 QC System were assessed and compared with current 10% random qualify control technique. MATERIALS AND METHODS: In clinical practice, a total of 18,592 "within normal limits" or "benign cellular changes" cases classified by The Bethesda System were rescreened by the Autopap System. In study for sensitivity of The AutoPap System to detect false negatives, a total of 1,680 "within normal limits" or "benign cellular changes" cases were rescreened both manually and by the AutoPap System. The sensitivity of the AutoPap System to these false negatives was assessed at 10% review rate to compare 10% random manual rescreen. RESULTS: In clinical practice, 38 false negatives were identified by the AutoPap System and we had achieved 0.2% reduction in the false negative rate of screening error. In study for sensitivity, 37 false negatives were identified by manual rescreening, and 23 cases(62.2%) of the abnormal squamous cytology were detected by the AutoPap System at 10% review rate. CONCLUSONS: The AutoPap 300 QC System is a sensitive automated rescreening device that can detect potential false negatives prior to reporting and can reduce false negative rates in the laboratory. The device is confirmed to be about eight times superior to the 10% random rescreen in detecting false negatives.

유두상 미성숙 화생의 자궁경부 세포진 소견

김혜선,선미임,김의정,김희숙,Kim, Hye-Sun,Seon, Mee-Im,Kim, Yee-Jung,Kim, Hy-Sook 대한세포병리학회 2002 대한세포병리학회지 Vol.13 No.1

Papillary immature metaplasia (PIM) of the uterine cervix (Immature condyloma) is a subset of low grade squamous intraepithelial lesion (LSIL) which is frequently associated with human papilloma virus (HPV) types 6 and 11. The histologic features of PIM include filiform papillae lined by evenly spaced immature metaplastic-type cells with frequent nucleoli, mild anisokaryosis, and a low mitotic index. To characterize the cytologic changes associated with PIM, we analyzed 14 cases of PIM from our file. We reviewed biopsy slides and the cervicovaginal smears taken proximate to the time of blopsy. Histologically, nine cases had either flat condyloma (7 cases) or high grade squamous intraepithelial lesion (HSIL) (2 cases). Cytologic changes included cells in various stages of maturation with karyomegaly (14 cases), cells with irregularities in the nuclear membrane (13 cases), intermediate cells with karyomegaly(13 cases), cells with binucleatlon (13 cases), and aborted koliocytes (11 cases) Cervicovaginal smears from all cases were interpreted as atypical squamous cells of undetermined significance (ASCUS), NOS or ASCUS, rule out squamous intraepithelial lesion (SIL) or LSIL in two cases with flat condyloma or HSIL in a case with severe dysplasia. PIM is a distinct histologic entity that can present with a spectrum of cytologic findings, but cytologic findings may resemble variable reactive conditions and immature HSIL. Therefore, it is difficult to diagnose PIM by cytology alone. However, the meticulous efforts for making the cytologic diagnoses which can Induce active management of patients are recommended because PIM is a variant of LSIL and frequently has a flat condyloma or HSIL.

자궁경부 미소침윤성 편평세포암종의 세포학적 분석

김은경,김의정,박종숙,김희숙,Kim, Eun-Kyung,Kim, Yee-Jeong,Park, Jong-Sook,Kim, Hy-Sook 대한세포병리학회 1994 대한세포병리학회지 Vol.5 No.2

We studied cervical cytology of 175 cases of histologically confirmed microinvasive squamous cell carcinoma of the uterine cervix in Cheil General Hospital from 1991 to 1993. Excluding 32 cases of insufficient smear, 143 cases were reviewed in view of background, cellularity, smear pattern, nuclear chromatin and presence of nucleoli. The characteristic findings of microinvasive carcinoma were syncytia and/or individual tumor cells in the focally necrotic inflammatory background. Nuclear chromatin was clear or fine. Nucleoli were observed in 55%. The prediction rate of microinvasive carcinoma was 74%. There is no significant relationship between the cellular features and depth of invasion.