宫颈特殊染色法、液基薄层细胞学及人乳头瘤病毒检测对宫颈癌前病变的应用价值分析

目的:探讨宫颈特殊染色法(FRD)、液基薄层细胞学(TCT)及人乳头瘤病毒(HPV)检测对宫颈癌前病变筛查的应用价值。方法:选取2015年1月～2018年1月于我院行宫颈癌筛查的1794例妇女作为研究对象,所有研究对象均接受FRD、TCT、HPV检测,以经阴道镜取样活检结果为阳性标准,对比分析三种不同检测方法以及联合检测的诊断效能。结果:病理科活检检出阳性111例,检出率为6.19%;FDR检测检出阳性114例,检出率为6.35%,漏诊率为16.22%;TCT检测检出阳性115例,检出率为6.41%,漏诊率为19.82%;HPV检测检出阳性108例,检出率为6.02%,漏诊率为19.82%;FRD检测与TCT、HPV检测的检出率比较差异无统计学意义(P0.05)。FRD检测敏感度为83.78%,特异度为98.75%,阳性预测值为81.58%,阴性预测值为98.93%;TCT检测敏感度为80.18%,特异度为98.46%,阳性预测值为77.39%,阴性预测值为98.69%;HPV检测敏感度为80.18%,特异度为98.87%,阳性预测值为82.41%,阴性预测值为98.70%;FRD、TCT、HPV联合检测敏感度为93.69%,特异度为99.52%,阳性预测值为92.86%,阴性预测值为99.58%;FRD、TCT、HPV联合检测与FRD、TCT、HPV单独检测的敏感度、阳性预测值比较差异具有统计学意义(P0.05)。结论:FRD、TCT、HPV检测对宫颈癌前病变的诊断效能相当,而FRD、TCT、HPV联合检测的诊断效能优于各方法单独检测。     

HPV16感染检测和TCT筛查联用的临床应用

目的评估人乳头瘤病毒(Human papillomavirus,HPV)16感染和液基薄层细胞学(thinprep cytologic test,TCT)筛查在预测宫颈病变中的临床价值。方法以门诊537例高危型HPV感染疑似宫颈病变女性为对象,进行HPV16感染分析、液基薄层细胞学和阴道镜病理检查,以病理活检为金标准,比较HPV16感染筛查方法、TCT筛查方法以及二者联用在筛查中的敏感度、特异度等指标,判断其临床应用价值。结果 HPV16感染筛查方法的敏感度为62.9%,特异度为83.5%,阳性预测值为53.4%,阴性预测值为88.2%;TCT筛查方法的敏感度为41.2%,特异度为92.7%,阳性预测值为62.9%,阴性预测值为84.0%;二者联合筛查,以HPV16感染或TCT异常为阳性,敏感度为84.7%,特异度为75.8%,阳性预测值为51.2%,阴性预测值为94.3%。结论 HPV16感染联合TCT异常筛查可以提高筛查的灵敏度,特异度也在可接受范围内,可以作为宫颈防癌初筛方法。     

B超引导下细针穿刺活检判断甲状腺结节性质的应用价值

目的:探讨B超及B超引导下的细针穿刺活检判断甲状腺结节性质的临床应用价值。方法:选取2018年1月～2019年10月我院收治的甲状腺结节患者200例,所有患者均接受B超检查和B超引导下细针穿刺检查,以手术病理结果为金标准,对比两种检查方式的灵敏度、特异度、阳性预测值、阴性预测值和准确率。结果:(1)200例患者共239个结节,手术病理结果证实良性结节64个,恶性结节175个;(2)B超引导下细针穿刺检查的灵敏度、特异度、阳性预测值、阴性预测值、准确率明显高于B超检查(P0.05);(3)B超引导下细针穿刺对不同大小结节的诊断的灵敏度、特异性、阳性预测值、阴性预测值、准确率均优于B超检查(P0.05)。结论:B超引导细针穿刺活检判断甲状腺结节性质的应用价值明显优于B超检查。     

超声内镜在上消化道黏膜下肿瘤诊断和鉴别诊断中的价值

目的:分析超声内镜(EUS)在上消化道黏膜下肿瘤(SMT)诊断价值。方法:选取我院收治的SMT患者81例,均进行EUS检查,且在院内进行内镜,或者手术治疗,将EUS诊断结果与术后的病理结果进行对比分析。结果:本组87处病变,经EUS诊断结果显示,平滑肌瘤35处,间质瘤36处,异位胰腺6处,脂肪瘤6处,类癌1处,囊肿1处,2处未做明确的诊断。经计算,EUS诊断SMT的阳性预测值79.31%,其中平滑肌瘤阳性预测值94.29%,间质瘤阳性预测值69.44%,异位胰腺阳性预测值83.33%,脂肪瘤阳性预测值66.67%。与术后病理诊断结果不符的EUS诊断病变共18处,诊断错误率20.69%,食管病变7处,胃病变10处,十二指肠病变1处。结论:EUS对上消化道SMT的诊断效果总体令人满意,但需要注意鉴别诊断,提高诊断准确率。     

TCT、HPV检测在宫颈锥切术后复发中的预测价值

目的:评估薄层液基细胞学检查(thinprep cytologic test,TCT)和人乳头瘤病毒(human papillomavirus,HPV)检测在宫颈锥切术后复发中的预测价值。方法:随访531例病理诊断为子宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ-Ⅲ级接受宫颈锥切术的患者,分别于术后3、6个月及术后每6-12月随访1次,以TCT及HPV检测作为随访的检测指标,若二者有一项异常,行阴道镜下活组织检查,病理证实存在子颈上皮内瘤变Ⅰ-Ⅲ级者视为复发。采用敏感度、特异度、阳性预测值、阴性预测值表示TCT、HPV检测性能。结果:531例患者中10%(54例)的患者出现不同级别的病变复发。TCT在术后预测病变复发的灵敏度77%,特异度72%;HPV在术后预测病变复发的灵敏度95%,特异度60%,TCT联合HPV预测病变复发的灵敏度100%,特异性80%。术后HPV负荷量100 RLU/PC者较HPV负荷量100 RLU/PC者而言术后病变复发的风险增高,差别有统计学意义(P0.01),术后HPV负荷量100 RLU/PC是锥切术后病变复发的高危因素。结论:使用细胞学联合HPV检测是有效的预测宫颈锥切术后病变复发的方法,术后高HPV负荷量与病变复发相关,并可对术后复发高风险人群进行分流,临床需严密随访。     

弹性成像定量分析联合硬环征在甲状腺良恶性结节鉴别诊断中的应用价值分析

目的:探究弹性定量分析联合硬环征在甲状腺良恶性结节鉴别诊断中的应用价值。方法:回顾性分析2018年1月至2018年9月于我院行手术或穿刺活检病理证实的121例甲状腺结节患者临床资料,所有患者均行弹性成像定量分析以及剪切波弹性成像(SWE)分析,计算弹性成像定量分析、SWE分析以及联合检测,以病理检查结果为金标准(良性78个,恶性43个),对甲状腺良恶性结节诊断的敏感性、特异度、准确性、阳性预测值以及阴性预测值,分别绘制弹性成像定量分析、SWE以及联合检测的受试者工作特征(ROC)曲线,并比较ROC曲线下面积。结果:(1)弹性定量分析诊断良性结节87个,恶性34个,敏感性73.08%,特异度30.23%,阳性预测值65.51%,阴性预测值38.24%;(2)SWE分析良性结节76个,恶性结节45个,敏感性64.10%,特异度39.53%,阳性预测值65.79%,阴性预测值37.78%;(3)联合检测良性结节73个,恶性结节48个,敏感性89.74%,特异度93.02%,阳性预测值95.89%,阴性预测值83.33%;(4)联合检测敏感性、特异度、阳性预测值及阴性预测值均高于单独检测(P 0.05);(5)弹性成像定量分析、SWE及联合检测ROC曲线下面积分别为0.843、0.819、0.940,联合检测准确率高于单一检测(P0.05);SWE分析甲状腺良恶性结节的弹性模量值Emean、Emin、Emax、Esd、Emean-p及Emean-m均显著大于恶性结节(P 0.05)。结论:弹性成像定量分析联合硬环征检测能够显著提高对甲状腺结节良恶性病变的诊断敏感性及特异度,具有较高的临床应用价值。     

阴道镜配合病理活检应用于宫颈疾病的诊断价值

目的评价电子阴道镜及宫颈病理活检对宫颈疾病的诊断价值。方法收集我院妇科门诊2003年至2006年宫颈疾病患者行阴道镜检查病行宫颈活检的病理结果进行对照分析。结果电子阴道镜检查后行宫颈活检1060例,病理结果显示:宫颈癌16例,宫颈上皮内瘤样变342例,宫颈炎性病变702例,阴道镜诊断宫颈上皮内瘤样变及宫颈癌的符合率分别为:93.44%和93.75%。结论阴道镜检查配合病理活检诊断宫颈疾病结果及时可靠,尤其对宫颈上皮内瘤样变的早诊断及降低宫颈癌的发生率有重要价值。     

经胸壁超声心动图在先天性心脏病患者左心室功能评价中的应用价值

目的:比较常规超声和经胸壁超声心动图筛查胎儿先天性心血管畸形的应用价值。方法:选择2012年1月到2017年2月在我院诊治的35例疑似胎儿先天性心脏病的产妇作为研究对象,所有产妇都接受常规超声和经胸壁超声心动图检查,再将结果与病理检查结果进行对比分析,判断其诊断效能。结果:在35例产妇中,病理检查结果显示102处心脏异常情况,其中房室间隔异常35处,动脉心室连接异常28处,房室连接异常25处,动脉干异常14处。二维联合超声心动图对各种类型心血管畸形的正确诊断率都高于常规超声(P0.05)。35例产妇胎儿的PI值为53.44±7.55,CPR值为62.99±5.39。常规超声检查对胎儿先天性心血管畸形的诊断敏感度、特异度、阳性预测值及阴性预测值分别为84.9%、50.0%、96.6%和16.7%,而二维联合超声心动图检查的敏感度、特异度、阳性预测值及阴性预测值分别为97.0%、100.0%、100.0%和66.7%,二维联合超声心动图检查的敏感度、特异度、阳性预测值及阴性预测值都高于常规超声(P0.05)。结论:超声检查在胎儿先天性心血管畸形诊断中具有重要的意义,经胸壁联合超声心动图检查有利于对心脏形态学进行客观评估,提高诊断效果,有很好的应用价值。     

CRP联合CA72-4, CEA, CA19-9检测对胃癌早期诊断的临床价值

目的:探究C反应蛋白(CRP)联合胃癌抗原(CA72-4)、癌胚抗原(CEA)、糖类抗原(CA19-9)检测对胃癌早期诊断的临床价值。方法:选择2014年3月~2016年6月我院收治的胃癌患者(103例)为胃癌组,包括早期胃癌患者30例,中晚期患者73例;同期就诊于我院的良性胃病患者为良性胃病组(61例),另选择20例年龄、性别相匹配的健康体检人群为健康对照组。比较三组人群血清C反应蛋白(CRP)、CA72-4、CEA、CA19-9水平,并探讨其表达与胃癌患者临床病理特征之间的关系。结果:早期胃癌组、良性胃病组患者的血清CRP、肿瘤标志物CA72-4、CEA、CA19-9的表达水平及阳性检测率均显著高于健康对照组(P0.05);早期胃癌组的上述指标显著高于良性胃病组(P0.05)。肿瘤分化程度低、发生转移、临床分期为Ⅲ,Ⅳ期胃癌患者的血清CRP、CA72-4、CEA、CA19-9阳性检测率显著高于肿瘤高分化、未发生转移、临床分期为Ⅰ、Ⅱ期的胃癌患者(p0.05)。血清CRP、CA72-4、CEA、CA19-9联合检测胃癌的敏感度92.23%,特异度为90.85%,联合检测敏感度显著高于CRP(68.93%)、CA72-4(71.84%)、CEA(77.67%)、CA19-9(59.22%)单项检测(p0.05)。结论:血清CRP、CA72-4、CEA、CA19-9水平与胃癌的临床病理特征密切相关,联合检测能显著提高检测灵敏度,有利于胃癌早期诊断。     

阴道镜及宫颈活组织检查对早期宫颈上皮内瘤变诊断价值分析

目的:探究阴道镜及宫颈活组织检查对早期宫颈上皮内瘤变(cervicalintraepithelialneoplasia,CIN)的诊断价值。方法:选择2015年3月至2018年5月于我院接受诊治的543例疑似宫颈上皮瘤变患者,分别对其实施阴道镜及宫颈活组织检查,以病理学检测结果为金标准,分别评估两种方式单独检测及联合检测对早期CIN的诊断一致性、灵敏度和特异度,并进行组间对比。结果:(1)543例疑似CIN患者病理诊断早期CIN阳性患者168例,阴性患者375例,诊断率为30.94%;阴道镜对早期CIN诊断发现阳性患者有143例,良性患者有400例,诊断率为26.34%;宫颈活组织检测对早期CIN诊断发现阳性患者有159例,良性患者有384例,诊断率为29.28%;阴道镜联合颈活组织检测对早期CIN诊断发现阳性患者有163例,良性患者有380例,诊断率为30.02%。(2)检测发现,阴道镜对早期CIN诊断一致性为81.77%,灵敏度为60.12%,特异度为91.47%。(3)宫颈活组织对早期CIN诊断一致性为91.71%,灵敏度为83.33%,特异度为95.47%。(4)阴道镜联合宫颈活组织对早期CIN诊断一致性为96.50%,灵敏度为92.86%,特异度为98.13%。(5)联合检测对早期CIN诊断的一致性、灵敏度和特异度均明显优于阴道镜及宫颈活组织单独检测。结论:阴道镜及宫颈活组织检测对早期CIN具有较好的诊断效果,但联合检测诊断准确率更高,适用于早期CIN临床筛查中。     

色素内镜联合CRP和TRF在青海地区早期食管癌患者的诊断价值

摘要 目的：探讨色素内镜联合C反应蛋白(C-reactive protein,CRP)和转铁蛋白(Transferrin,TRF)在青海地区早期食管癌患者的诊断价值。方法：2018年6月至2020年3月选择在本院进行食管癌筛查的青海地区患者250例,所有患者都给予色素内镜检查,同时给予血浆CRP和TRF检查并判断诊断价值。结果：在250例患者中,病理诊断为原位癌28例,高级别上皮内瘤变10例,低级别上皮内瘤变12例,慢性炎症200例;其中早期食管癌38例。卢戈液色素内镜显示不染色47例,淡染色95例,浓染色108例。早期食管癌患者的血浆CRP值都高于非早期食管癌患者,TRF值低于(P<0.05)。Pearson相关性分析显示早期食管癌与色素内镜卢戈液不染色、CRP、TRF值存在相关性(P<0.05)。色素内镜联合CRP和TRF在青海地区早期食管癌的诊断敏感性与特异性分别为97.4 %和100.0 %。结论：色素内镜联合CRP和TRF在青海地区早期食管癌患者诊断中的应用具有很好的敏感性与特异性,能有效预测早期食管癌发生情况,对早期诊治早期食管癌具有一定的指导意义。     

Diverse glandular pathologies coexist with high-grade squamous intraepithelial lesion in cyto-histological review of atypical glandular cells on ThinPrep specimens

Objective: To identify in cytology, high‐grade squamous intraepithelial lesions with endocervical glandular extension in cases previously diagnosed as atypical glandular cells (AGC), analyse possible reasons for the diagnostic pitfall and document the frequency of glandular pathology coexisting with high‐grade cervical intraepithelial lesion in histology. Methods: Thirty‐nine ThinPrep® cervical smear (Pap) tests reported as AGC of undetermined significance and showing high‐grade lesions on histology [cervical intraepithelial neoplasia (CIN) 2 or 3, endometrial or extrauterine adenocarcinoma] were reviewed retrospectively to identify the cases of high‐grade squamous intraepithelial lesion with endocervical glandular extension, using the Bethesda 2001 system. Cyto‐histological correlation was performed. Results: A high frequency of diverse glandular pathologies coexisted with high‐grade cervical intraepithelial lesions on histology. This included endocervical glandular extension in 63%, benign glandular pathology in 33% and pre‐neoplastic or malignant glandular pathology (endocervical glandular dysplasia, adenocarcinoma in situ and metastatic breast carcinoma) in 17% cases. On cytology, the sensitivity was 40%, specificity was 80% and positive predictive value was 86% for endocervical gland extension in high‐grade squamous intraepithelial lesions. Conclusions: Special efforts to recognize endocervical glandular extension in high‐grade squamous intraepithelial lesions and glandular neoplasia coexisting with squamous intraepithelial lesions from the heterogeneous category of AGC can contribute to increasing the diagnostic accuracy. The identification of endocervical glandular extension on cervical cytology would alert the gynaecologist to perform a thorough assessment of the endocervix during colposcopy. This could also help to decide on the need to perform deeper conization rather than loop electrosurgical excision procedure to ensure negative margins when colposcopic biopsy shows CIN 2 or 3.     

Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia.

To assess the variability among histopathologists in diagnosing and grading cervical intraepithelial neoplasia eight experienced histopathologists based at different hospitals examined the same set of 100 consecutive colposcopic cervical biopsy specimens and assigned them into one of six diagnostic categories. These were normal squamous epithelium, non-neoplastic squamous proliferations, cervical intraepithelial neoplasia grades I, II, and III, and other. The histopathologists were given currently accepted criteria for diagnosing and grading cervical intraepithelial neoplasia and asked to mark their degree of confidence about their decision on a visual linear analogue scale provided. The degree of agreement between the histopathologists was characterised by kappa statistics, which showed an overall poor agreement (unweighted kappa 0.358). Agreement between observers was excellent for invasive lesions, moderately good for cervical intraepithelial neoplasia grade III, and poor for cervical intraepithelial neoplasia grades I and II (unweighted kappa 0.832, 0.496, 0.172, and 0.175, respectively); the kappa value for all grades of cervical intraepithelial neoplasia taken together was 0.660. The most important source of disagreement lay in the distinction of reactive squamous proliferations from cervical intraepithelial neoplasia grade I. The histopathologists were confident in diagnosing cervical intraepithelial neoplasia grade III and invasive carcinoma (other) but not as confident in diagnosing cervical intraepithelial neoplasia grades I and II and glandular atypia (other). Experienced histopathologists show considerable interobserver variability in grading cervical intraepithelial neoplasia and more importantly in distinguishing between reactive squamous proliferations and cervical intraepithelial neoplasia grade I. It is suggested that the three grade division of cervical intraepithelial neoplasia should be abandoned and a borderline category introduced that entails follow up without treatment.     

阴道镜检查在宫颈上皮内瘤样病变诊断中的价值

目的：探讨阴道镜检查在宫颈上皮内瘤样病变诊断中的价值。方法：回顾性分析我院自2004年10月至2006年6月528例阴道镜检查结果。结果：528例中行阴道镜和病理检查的有321例,阴道镜下诊断宫颈上皮内瘤样病变（CIN）76例,经病理确诊CIN51例,诊断符合率为67.11%;这两组用t检验,P〉0.05无统计学意义。同时行阴道镜检查和宫颈新柏氏膜式液基层细胞学检测（简称TCT）的324例患者进行分析表明,随着细胞学诊断分级的升高,阴道镜正常图像比例逐渐减少,异常图像比例逐渐增多。结论：阴道镜作为一种宫颈癌前病变和早期癌的重要方法之一,越来越受到临床医师的重视,它具有不与患者直接接触,对患者无任何损害,不造成任何不良影响,价格适中等优点,阴道镜可作为我国目前CIN和早期宫颈癌筛查的最佳方法,但最后确诊仍依靠病理学检查。     

Diagnostic and prognostic significance of image cytometric DNA ploidy measurement in cytological samples of cervical squamous intraepithelial lesions

D. Demirel, N. Akyürek and I. Ramzy
Diagnostic and prognostic significance of image cytometric DNA ploidy measurement in cytological samples of cervical squamous intraepithelial lesions Objective: To study the DNA ploidy pattern of uterine cervical squamous intraepithelial lesions (SILs) and its diagnostic and prognostic significance. Methods: The study included 31 cases of SIL: 11 low‐grade (LSIL) and 20 high‐grade (HSIL). Feulgen–pararosaniline staining was performed on previously Papanicolaou‐stained smears and a DNA image cytometric study was performed. An internal reference was used to calibrate the samples. Results: All 31 cases of SIL, either LSIL or HSIL, were non‐diploid. Of the 11 cases of LSIL, four were tetraploid and seven were aneuploid, whereas, of the 20 cases of HSIL, four were tetraploid and 16 were aneuploid. Stemline aneuploidy was not a significant discriminator between LSIL and HSIL (P = 0.32). Based on single‐cell analysis, HSIL cases had significantly higher DNA content than LSIL cases (P < 0.01). When a mean of 30% or more was used for the 6c‐exceeding event (6cEE) value, the sensitivity and specificity to indicate HSIL were 83% and 64%, respectively, with a positive predictive value (PPV) of 81% and negative predictive value (NPV) of 65%. All HSIL cases were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) on biopsy. In addition, cases which showed recurrence had more DNA content by single‐cell analysis than those with an indolent clinical behaviour: P = 0.04 and P = 0.03 for LSIL and HSIL, respectively. Conclusions: Image cytometric DNA analysis is a useful technique for diagnostic and prognostic purposes in uterine cervical SIL when appropriate ‘c’ values are used in single‐cell analysis. We propose that a >6c DNA content of 30% is useful as a cut‐off level for predicting cases with CIN2+ in DNA image cytometry of cervical smears.     

外周血miR-17-92基因簇对于早期胃癌的诊断及预测价值

目的:探讨外周血mi R-17-92簇对早期胃癌的诊断价值,为胃癌的早期诊断及治疗提供参考依据。方法:收集胃癌125例(Ⅰ期35例,Ⅱ期28例,Ⅲ期39例,Ⅳ期23例)和癌前病变24例(包括肠化生及上皮内瘤变),同时选择65例慢性胃炎作为对照组。采用实时荧光定量PCR技术(Real-time quantitative PCR,RT-qPCR)检测患者血清中的mi R-17-92基因簇的表达水平。通过受试者工作曲线(Receiver Operating Curve, ROC)及曲线下的面积(Area Under the Curve,AUC)评估mi R-17-92基因簇表达水平诊断早期胃癌的敏感性和特异性。结果:(1)慢性胃炎与癌前病变mi R-17-92基因簇表达比较无显著差异(P0.05);(2)早期胃癌及进展期胃癌mi R-17-5p表达明显高于慢性胃炎(P0.05),mi R-19a-3p、mi R-19b-3p、mi R-20a-5p和mi R-92a-3p表达则显著低于慢性胃炎及进展期胃癌(P0.05);(3)miR-17-5p诊断早期胃癌的曲线下面积较mi R-19a-3p、mi R-19b-3p、mi R-20a-5p、mi R-92a-3p及CEA更高;(4)miR-19a-3p、mi R-19b-3p、mi R-20a-5p、mi R-92a-3p高低表达组与在胃癌的浸润深度间有显著性差异(P0.05),mi R-19b-3p高低表达组在胃癌的临床分期间有显著性差异(P0.05);(5)miR-17-5p、mi R-19a-3p、mi R-19b-p、mi R-20a-5p、mi R-92a-3p诊断早期胃癌的阳性率较CEA、CA199高。结论:外周血mi R-17-92基因簇对于早期胃癌的诊断价值明显优于CEA和CA199,这可能为胃癌的早诊早治提供新的策略。     

Outcomes of cervical liquid-based cytology suggesting a glandular abnormality

Objective: To ascertain the positive predictive value of both ?glandular neoplasia (national standard code 6) and borderline change (national standard code 8) in glandular cells in liquid‐based cervical cytology specimens in Cardiff and Vale NHS Trust and to outline the histological outcomes of these cases. Method: Eighty‐nine liquid‐based (Surepath?) cervical cytology cases were retrospectively identified from a 2‐year period (January 2005 to December 2006) and correlated with histopathological diagnoses. Results: Initial punch biopsy histology revealed 18 cases (21%) of cervical glandular intraepithelial neoplasia (CGIN). A further nine cases (10%) of CGIN were identified following local excision or hysterectomy. Ten cases of invasive malignancy were identified: four endocervical adenocarcinomas (all node negative, TNM stage T1b1), five endometrial adenocarcinomas and one squamous cell carcinoma. There were 10 with high‐grade cervical intraepithelial neoplasia (CIN) alone. Women diagnosed with endometrial malignancy presented later with an average age of 64.6 years compared with 34.9 years for endocervical lesions. Taking high‐grade CIN or worse as a positive outcome, the overall positive predictive value (PPV) of glandular abnormalities on cytology (both code 6 and 8) was 58.1% [95% confidence interval (CI) 47.8, 68.4]. PPV for borderline change in glandular cells alone was 24.1% (95% CI 8.5, 39.6) and for ?glandular neoplasia alone 75.4% (95% CI 64.3, 86.5). Conclusion: With our interpretation of the classification, women with cytological diagnoses of glandular neoplasia of the cervix should initially be investigated by local resection rather than punch biopsy, and those with borderline change in glandular cells with repeat cytology.