Mintzer M, Curtis P, Resnick J C, Morrell D
Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill 27514, USA.
Cancer. 1999 Jun 25;87(3):113-7.
Controversy continues regarding the relation between the quality of Papanicolaou (Pap) smears, especially the presence of endocervical cells (ECC), with the finding of cytologic abnormalities.
As part of a study regarding performance feedback on the quality of Pap smears, data from 56,475 Pap smears obtained by 176 participating clinicians over a 20-month period were analyzed to assess the relation between the presence of ECC, the categorization of global specimen adequacy as "satisfactory" or "satisfactory with limitations," and the prevalence of atypia and squamous intraepithelial lesions (SILs).
Atypia was less likely to be found in "satisfactory" Pap smears than in "satisfactory with limitations" quality Pap smears (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.5-0.6; P < 0.001), even though the latter could contain ECC. No association was found between satisfactory Pap smears and cytologic abnormalities. Compared with specimens with no ECC, an ECC count of > or = 50 on a slide was associated positively with the detection of atypia (OR, 2.1; 95% CI, 1.8-2.4; P < 0.001) or SILs (OR, 1.7; 95% CI, 1.3-2.2; P < 0.001). A similar relation existed between ECC counts of 25-50 (OR, 1.9; 95% CI, 1.1-2.2; P = 0.01) and the detection of SILs. No relation was found between specimens with < 25 ECC and the presence of atypia or abnormalities.
The global adequacy criterion of "satisfactory" assigned to a Pap smear does not indicate that there is a greater likelihood of detecting cytologic abnormalities compared with lower quality Pap smears. To the authors' knowledge, previous studies regarding the link between ECC in the Pap smear and cytologic abnormalities have not addressed the relevance of how many ECC are needed to maximize the identification of abnormalities. The data from the current study support the value of obtaining at least 25 ECC as a quality indicator of sampling.
关于巴氏涂片质量，尤其是宫颈管细胞（ECC）的存在与细胞学异常发现之间的关系，争议仍在继续。
作为一项关于巴氏涂片质量绩效反馈研究的一部分，分析了176名参与临床医生在20个月期间获得的56475例巴氏涂片数据，以评估ECC的存在、整体标本充足性分类为“满意”或“有局限性的满意”与异型性和鳞状上皮内病变（SIL）患病率之间的关系。
在“满意”的巴氏涂片中发现异型性的可能性低于“有局限性的满意”质量的巴氏涂片（优势比[OR]，0.6；95%置信区间[CI]，0.5 - 0.6；P < 0.001），尽管后者可能包含ECC。在满意的巴氏涂片与细胞学异常之间未发现关联。与无ECC的标本相比，玻片上ECC计数≥50与异型性检测呈正相关（OR，2.1；95%CI，1.8 - 2.4；P < 0.001）或SIL检测呈正相关（OR，1.7；95%CI，1.3 - 2.2；P < 0.001）。ECC计数为25 - 50时与SIL检测之间也存在类似关系（OR，1.9；95%CI，1.1 - 2.2；P = 0.01）。ECC < 25的标本与异型性或异常的存在之间未发现关系。
巴氏涂片评定为“满意”的整体充足性标准并不表明与质量较低的巴氏涂片相比，检测到细胞学异常的可能性更大。据作者所知，先前关于巴氏涂片中ECC与细胞学异常之间联系的研究尚未涉及需要多少ECC才能最大程度识别异常的相关性。本研究数据支持获取至少25个ECC作为采样质量指标的价值。
