Apgar B S, Brotzman G
Department of Family Medicine, University of Michigan Medical School, Ann Arbor, USA.
Am Fam Physician. 1999 May 15;59(10):2794-801.
Minor cytologic abnormalities of the cervix, such as atypical squamous cells of undetermined significance (ASCUS), are vastly more common than high-grade squamous intraepithelial lesions or invasive cancer. Current guidelines for the management of ASCUS include repeating the Papanicolaou (Pap) smear at specific intervals, referring all patients for colposcopy or using an adjunctive test such as hybrid capture human papillomavirus (HPV) testing or cervicography. The usefulness of the Pap smear is limited by its considerable false-negative rate and its dependence on clinician and laboratory performance. Colposcopy is a highly sensitive procedure, but many patients with ASCUS have normal colposcopic findings. The hybrid capture test not only measures quantitative HPV load but also detects both oncogenic and nononcogenic HPV types, thereby increasing the probability that serious cervical disease is not missed. Hybrid capture sampling is simple to perform, and positive results are strongly associated with cervical dysplasia. HPV testing in women with ASCUS can be used as an adjunctive test to identify those with HPV-associated disease; it can also serve as a quality assurance measure. Together, repeat Pap smears and HPV testing should identify most patients with underlying cervical dysplasia. Combined testing may also minimize the number of unnecessary colposcopic examinations in women who have no disease.
宫颈的微小细胞学异常，如意义不明确的非典型鳞状细胞（ASCUS），远比高级别鳞状上皮内病变或浸润性癌更为常见。目前针对ASCUS的管理指南包括在特定间隔重复巴氏涂片检查、将所有患者转诊进行阴道镜检查或使用辅助检测，如杂交捕获人乳头瘤病毒（HPV）检测或宫颈造影。巴氏涂片的效用受到其相当高的假阴性率以及对临床医生和实验室表现的依赖的限制。阴道镜检查是一项高度敏感的检查，但许多ASCUS患者的阴道镜检查结果正常。杂交捕获检测不仅能测量HPV定量负荷，还能检测致癌和非致癌HPV类型，从而增加不遗漏严重宫颈疾病的可能性。杂交捕获采样操作简单，阳性结果与宫颈发育异常密切相关。对ASCUS女性进行HPV检测可作为辅助检测，以识别患有HPV相关疾病的患者；它还可作为一项质量保证措施。重复巴氏涂片检查和HPV检测应能共同识别出大多数患有潜在宫颈发育异常的患者。联合检测还可减少对无疾病女性进行不必要阴道镜检查的次数。
