摘要目的:探讨宫颈腺癌（普通型）活检组织的形态学特征对肿瘤侵袭模式及预后的预测价值。方法:收集2010—2019年同济大学附属第一妇婴保健院的32对宫颈腺癌样本（32例分期手术标本，32例活检标本），分析活检标本中肿瘤性坏死碎屑（necrotic tumor debris，NTD）、细胞核级及核分裂象计数与子宫切除标本的间质浸润模式和淋巴结状态的相关性。结果:肿瘤浸润模式能很好地应用于宫颈腺癌切除标本，但其在活检标本中的作用有限。由于活检组织较小，仅14例（14/32， 43.8%）活检标本可进行浸润模式分型，与切除标本的符合率为37.5%。活检标本中NTD（9/19）和3级核（11/19）与C型浸润和淋巴结转移密切相关（ P<0.05）。在活检标本中同时评估NTD和/或细胞核级时，对C型浸润的灵敏度更高。 结论:评估宫颈腺癌活检组织中NTD和/或细胞核级对淋巴结转移状态和间质浸润类型有很好地预测价值， 有助于患者分层管理，避免不必要的分期手术。

abstractsObjective:To evaluate the pathologic findings from biopsy samples to predict the status of nodal metastasis for patients with usual cervical adenocarcinoma.Methods:The 32-pair samples of cervical adenocarcinoma specimens (32 cervical biopsies and 32 hysterectomies with staging) from 2013 to 2019 were selected for retrospective study in Shanghai first Maternal and infant Health Care Hospital Affiliated to Tongji University. The correlation between histopathologic features including necrotic tumor debris (NTD), nuclear grade, mitotic count and pattern-based classification system and the status of lymph node metastasis was evaluated.Results:Tumor invasive patterns of cervical adenocarcinoma, as described previously, could be discerned in hysterectomy/staging specimens, but not in cervical biopsies. Because the biopsy tissues were small, only 14(14/32, 43.8%) cases could be classified according to pattern of invasion, and the concordance rate with resected specimens was 37.5%. NTD (9/19) and grade 3 nuclei (11/19) were positively correlated with invasive pattern C and nodal metastases ( P<0.05). Moreover, when NTD and (or) nuclear grade were evaluated at the same time, the sensitivity for type C infiltration was higher. Conclusions:Evaluation of NTD and nuclear grade in biopsies for cervical adenocarcinoma provides good predictive value for lymph node metastasis. It is helpful for patient stratification and management andto avoid unnecessary staging procedures. However, multicenter studies and prospective clinical trials are necessary to confirm the findings before clinical application can be considered.