Zardawi Ibrahim M, Rode Jurgen W
Mayne Health, Newcastle Laboratory, PO Box 801, Newcastle, NSW 2300, Australia.
Acta Cytol. 2002 May-Jun;46(3):495-8. doi: 10.1159/000326867.
To determine the clinical value of a repeat (second) Pap smear at the time of colposcopy in the management of patients with recent cytologic abnormalities.
A study of paired Pap smears and their corresponding cervical biopsies during a two-year period, commencing in June 1996, was undertaken. Pap smears and cervical biopsies from 614 patients were evaluated in the Department of Pathology, Royal Darwin Hospital, Northern Territory, Australia. To maintain uniformity, the cytologic and histologic findings were assessed according to the Bethesda System.
The original (first) Pap smears included 288 high grade and 326 low grade lesions. The second smears showed 200 high grade, 221 low grade, 167 normal and 26 unsatisfactory cases. Punch biopsies revealed 242 high grade, 300 low grade and 72 inflammatory/reactive lesions. The changes noted in the second Pap smears and in the punch biopsies in the group originally diagnosed as having high grade disease were generally less advanced. The second Pap smears and corresponding cervical punch biopsies showed more advanced changes in the group originally diagnosed as having low grade disease. Removal of part of the abnormal epithelium during the first Pap smear and the desire of the colposcopist not to damage the surface epithelium prior to performing a cervical biopsy may account for some of these findings. Sampling errors and morphological misinterpretation may explain some of the findings.
In the second smears, new cases of high grade abnormality were discovered mainly in patients with low grade changes on the first smears. Therefore, a second Pap smear at the time of colposcopy is justifiable in the group with low grade changes on the first smear.
确定在阴道镜检查时重复（第二次）巴氏涂片检查在近期细胞学异常患者管理中的临床价值。
对1996年6月开始的两年期间配对的巴氏涂片及其相应的宫颈活检进行了研究。澳大利亚北领地皇家达尔文医院病理科对614例患者的巴氏涂片和宫颈活检进行了评估。为保持一致性，根据贝塞斯达系统对细胞学和组织学结果进行评估。
最初（第一次）的巴氏涂片包括288例高级别病变和326例低级别病变。第二次涂片显示200例高级别、221例低级别、167例正常和26例不满意病例。活检显示242例高级别、300例低级别和72例炎症/反应性病变。最初诊断为高级别疾病组的第二次巴氏涂片和活检中发现的变化通常进展较小。最初诊断为低级别疾病组的第二次巴氏涂片和相应的宫颈活检显示变化更进展。第一次巴氏涂片时部分异常上皮的去除以及阴道镜检查者在进行宫颈活检前不想损伤表面上皮可能是这些发现的部分原因。抽样误差和形态学误判可能解释了一些发现。
在第二次涂片中，主要在第一次涂片有低级别变化的患者中发现了新的高级别异常病例。因此，对于第一次涂片有低级别变化的组，在阴道镜检查时进行第二次巴氏涂片检查是合理的。
