[Pregnancy related cervical cytological changes and clinical management].

OBJECTIVE: To investigate characteristics of cervical cytology and management in pregnant women.

METHODS: From Aug. 2006 to Jan. 2010, 5152 pregnant women who received antenatal and postpartum examination underwent cervical cytological screening by liquid-based cytological test (LCT) in China-Japan Friendship Hospital. The cytological diagnosis was in accordance with the Bethesda system (TBS) 2001 diagnosis and classification system. The abnormal LCT results were followed up at 3 months after postpartum. The diagnosis of high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) were based on colposcopic examination and biopsy during pregnant. The diagnosis of atypical glandular cells (AGC) was based on curettage and biopsy at postpartum 6 weeks. The histopathology of biopsy were compared and analyzed.

RESULTS: (1) Cervical cytological changes related with pregnancy: among 5152 cases, it was found navicular cells in 3215 cases (62.40%), decidual cells in 783 cases (15.20%), reactive glandular cells in 369 cases (7.16%), and trophoblastic cells in 55 cases (1.07%). (2) LCT results: among 5152 cases, the normal samples were 4125 cases (80.07%), the inflammatory samples were 542 cases (10.52%), and the samples of abnormal epithelial cells were 485 cases (9.41%). Among those abnormal cases, 291 cases (5.65%) were in atypical squamous cells (ASC), 153 cases (2.97%) were in low-grade squamous intraepithelial lesions (LSIL), 33 cases (0.64%) were in HSIL, 1 case (0.02%) were in SCC and 7 cases (0.14%) were in AGC. (3) Histological pathology results: all women with HSIL and SCC underwent colposcopic examination and biopsy, it was found 28 cases in cervical intraepithelial neoplasia (CIN)II-III, 1 cases in adenosquamous carcinoma. 7 women underwent curettage and biopsy at postpartum 6 weeks which were diagnosed by AGC, the histopathological diagnosis was all negative. The concordance rate of cytopathologic and histopathologic diagnosis was 71% (29/41). (4) FOLLOW-UP: 485 women with abnormal LCT results were all followed up to 3 months at postpartum. Women with HSIL, SCC and AGC undergoing biopsy showed normal LCT results during follow-up. Those women with ASC and LSIL did not undergo colposcopic examination and biopsy. The regression rate was 72.3% (321/444) at postpartum 3 months.

CONCLUSIONS: The navicular cells were primarily morphological characteristics of cytology during pregnant and postpartum women. Some changes were easily confused with malignant lesions. It should be careful discrimination, and avoid excessively diagnosis and misdiagnosis. It suggested that we should follow up those women closely and expand the indication of colposcopic biopsy.