Bulten J, de Wilde P C, Boonstra H, Gemmink J H, Hanselaar A G
Department of Pathology, University Hospital Nijmegen, Nijmegen, 6500 HB, The Netherlands.
Gynecol Oncol. 2000 Nov;79(2):225-9. doi: 10.1006/gyno.2000.5943.
Atrophic cervical epithelium of postmenopausal women may mimic high-grade cervical intraepithelial neoplasia (CIN2-3) in Papanicolaou-stained cervical smears (Pap smears). Women with such an "atypical" Pap smear need a repeated Pap smear after a course of estrogens before a definite diagnosis can be made. The aim of this study was to determine whether measurement of proliferative activity in Pap smears of postmenopausal patients that were difficult to interpret is a reliable test for differentiating between cervical atrophy and high-grade CIN.
Pap smears obtained before and after estrogen treatment of 30 postmenopausal women with an atypical Pap smear were restained with the monoclonal antibody MIB1 to visualize proliferating cells. The proliferative activity index (PAI) was subsequently measured in order to explore the feasibility of a recently proposed PAI-based diagnostic decision tree to reduce the number of estrogen courses and follow-up Pap smears in postmenopausal women.
The PAI-based test to discriminate between cervical atrophy and high-grade CIN resulted in 100 and 96% correct diagnoses in women with high-grade CIN and cervical atrophy, respectively. Only 2 of the 30 women would have needed a repeated Pap smear after estrogen treatment for definite diagnosis if the PAI-based diagnostic decision had been used.
Measurement of PAI in MIB1 restained Pap smears is a simple, reliable, safe, and probably also cost-effective method to obtain a substantial reduction of diagnostic estrogen courses and subsequent Pap smears in postmenopausal women with an atypical Pap smear.
绝经后女性的萎缩性宫颈上皮在巴氏染色的宫颈涂片（巴氏涂片）中可能类似高级别宫颈上皮内瘤变（CIN2 - 3）。有这种“非典型”巴氏涂片的女性在明确诊断前需要在接受一个疗程的雌激素治疗后重复进行巴氏涂片检查。本研究的目的是确定对难以解读的绝经后患者巴氏涂片进行增殖活性测量是否是区分宫颈萎缩和高级别CIN的可靠检测方法。
对30名有非典型巴氏涂片的绝经后女性在雌激素治疗前后获取的巴氏涂片用单克隆抗体MIB1重新染色以观察增殖细胞。随后测量增殖活性指数（PAI），以探讨最近提出的基于PAI的诊断决策树在减少绝经后女性雌激素疗程数量和后续巴氏涂片检查方面的可行性。
基于PAI区分宫颈萎缩和高级别CIN的检测方法在高级别CIN和宫颈萎缩女性中分别得出了100%和96%的正确诊断。如果使用基于PAI的诊断决策，30名女性中只有2名在雌激素治疗后需要重复进行巴氏涂片以明确诊断。
在MIB1重新染色的巴氏涂片中测量PAI是一种简单、可靠、安全且可能具有成本效益的方法，可大幅减少有非典型巴氏涂片的绝经后女性的诊断性雌激素疗程及后续巴氏涂片检查。
