THE CLASSIFICATION OF CYTOLOGIC FINDINGS OF CERVIX UTERI »ZAGREB 2002« The Modification of the »Zagreb 1990« and »NCI Bethesda System 2001« Classifications

Abstract

»Zagreb 2002«, nova jedinstvena klasifikacija citoloških nalaza vrata maternice u Hrvatskoj, predstavlja modifikaciju klasifikacija »Zagreb 1990« i »NCI Bethesda system 2001«. Za ocjenu primjerenosti uzorka koriste se dvije skupine, »zadovoljava« i »ne zadovoljava«, s tim da ocjena ne zadovoljava uključuje i uzorke koji nisu analizirani kao i one koji su analizirani ali procjena abnormalnosti nije moguća, uz dodatna objašnjenja razloga. Prema općoj podjeli nalazi se klasificiraju kao »negativno na intraepitelnu ili invazivnu leziju« (uredan nalaz, promjene uz reaktivne i reparatorne¬ reakcije, nalaz koji ukazuje na određeni rizik) i »abnormalne stanice« (stanične promjene koje su morfološki u skladu s intraepitelnim ili invazivnim malignim lezijama). Opisna dijagnoza sadrži rubrike »mikroorganizmi«, »drugi ne-neoplastični nalazi« i »abnormalne stanice« (skvamozne, glandularne, neodređena značenja i druge maligne neoplazme). U skupinu »Drugi ne-neoplastični nalazi«, koji se mogu naći uz ili bez abnormalnih stanica, svrstane su reaktivne promjene na stanicama, reparatorni epitel, rezervne stanice, parakeratoza, diskeratoza, hiperkeratoza, nalaz cilindričnih stanica iza histerektomije, nalaz endometralnih stanica izvan ciklusa ili u postmenopauzi, te konstatacija da citohormonski status ne odgovara dobi i/ili anamnezi. Skvamozne lezije su podijeljene u tri skupine: »atipične skvamozne stanice« (ASC), »skvamozna intraepitelna lezija« (SIL) i »carcinoma planocellulare«. Novost je da unutar kategorije atipične skvamozne stanice (ASC) razlikujemo pod¬skupine: »neodređena značenja« (ASC-US), »ne može se isključiti HSIL« (ASC-H) i »ne može se isključiti invazija«. Za skupinu skvamozna intraepitelna lezija (SIL) u upotrebi su i dalje sva tri aktualna nazivlja, a jedina promjena se odnosi na dodatak »početna invazija se ne može isključiti«, koja se odnosi na inače karakteristične citološke slike karcinoma in situ s nekim promjenama na stanicama i podlozi, koje ukazuju na mogućnost rane invazije strome. Glandularne lezije su također podijeljene u tri skupine: »atipične glandularne stanice« (tri podskupine; vjerojatno reaktivne, vjerojatno intraepitlne i vjerojatno invazivne), »adenocarcinoma in situ« (AIS) i »adenocarcinoma«, uz naznaku¬ porijekla.¬ Skupina »abnormalne stanice neodređena značenja« i skupina »druge maligne neoplazme« se odnosi na abnormalnosti, gdje je/nije moguće postaviti diferencijalnu citološku dijagnozu.»Zagreb 2002«, a new unique classification of cytologic findings of the cervix uteri in Croatia presents the modification of the »Zagreb 1990« and »NCI Bethesda system 2001« classifications. There are two categories, that are »adequate« and »inadequate«, applied for the assessment of specimen adequacy. The category of inadequate also includes specimen that have not been analysed as well as the ones that have been analysed but the abnormality assessment cannot be given for whatever the reason is, accompanied by the additional explanation. According to the general division, the findings are classified as »negative for intraepithelial or invasive lesion« (no irregularities, changes with reactive and reparative reactions, results indicating certain risk) and »abnormal cells« (cellular changes which morphologically are in compliance with intraepithelial or invasive malignant lesions). Descriptive diagnosis contains the following sections: »micro-organisms«, »other non-neoplastic findings« and »abnormal cells« (squamous, glandular, non-defined and other malignant lesions). Reactive cellular changes, reparative epithelium, reserve cells, parakeratosis, dyskeratosis, hyperkeratosis, glandular cells status post hysterectomy, endometrial cells finding out of the cycle or during the postmenopause, as well as the definition that cytohormonal status is not adequate to the age and/or anamnesis all pertain to the category of »other non-neoplastic findings«, that can be found with or without abnormal cells. Squamous lesions are divided into the three groups: »atypical squamous cells« (ASC), »squamous intraepithelial lesion« (SIL) and »carcinoma planocellulare«. The news is there are the three subgroups, those are »non defined« (ASC-US), »HSIL cannot be excluded« (ASC-H) and »invasion cannot be excluded« within the category of »atypical squamous cells«. There are still three current names applied for the category of squamous intraepithelial lesion (SIL). The only change concerns the supplement »initial invasion cannot be excluded« which refers to typical cytologic pictures of carcinoma in situ with several changes on cells and the base that indicate the possibility of the early stroma invasion. Glandular lesions are also divided into the three groups: »atypical glandular cells« (three subgroups: »favor reactive, favor intraepithelial and favor invasive), »adenocarcinoma in situ« (AIS) and »adenocarcinoma«, accompanied by the suggestion of origin. The »abnormal non-defined cells« group and »other malignant neoplasms« group refer to abnormalities where it is not/is possible to set a differential cytologic diagnosis