Hockstad R L
Doctors Park Family Physicians, Escanaba, Michigan 49829.
Fam Pract Res J. 1992 Mar;12(1):53-60.
This pilot study explores the screening techniques for premalignant and malignant disease of the cervix. Given current knowledge of the etiology and progression of cancer of the cervix, should family physicians screen patients with Papanicolaou (Pap) smears, Human Papillomavirus (HPV) smears, colposcopy, or some combination of these three? In a retrospective audit of 75 patients comparing simultaneous Pap smears and colposcopy, 5 of 8 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) and one with invasive cancer had normal Pap smears. Because of this high false-negative Pap smear rate, a prospective study comparing a simultaneous Pap smear, HPV smear, and colposcopic examination (with biopsy when indicated) was undertaken. Seventy consecutive patients seen by the author for routine pelvic examinations consented to and were enrolled in the study. Seven patients had biopsy-proven CIN lesions; 2 were found by Pap smear, 3 by colposcopy, and 5 by HPV smear. The Pap smear missed 5 lesions, colposcopy missed 4, and the HPV smear missed 2. Further studies are needed to determine the optimal screening method for CIN.
这项试点研究探索了子宫颈癌前病变和恶性疾病的筛查技术。鉴于目前对子宫颈癌病因和进展的了解，家庭医生应该用巴氏涂片、人乳头瘤病毒（HPV）涂片、阴道镜检查，还是这三种方法的某种组合来筛查患者呢？在一项对75例患者同时进行巴氏涂片和阴道镜检查的回顾性审计中，8例经活检证实为宫颈上皮内瘤变（CIN）的患者中有5例以及1例浸润癌患者的巴氏涂片结果正常。由于巴氏涂片的假阴性率较高，因此开展了一项前瞻性研究，比较同时进行的巴氏涂片、HPV涂片和阴道镜检查（必要时进行活检）。作者接诊的70例因常规盆腔检查前来就诊的患者同意并参与了该研究。7例患者经活检证实有CIN病变；2例通过巴氏涂片发现，3例通过阴道镜检查发现，5例通过HPV涂片发现。巴氏涂片漏诊了5个病变，阴道镜检查漏诊了4个，HPV涂片漏诊了2个。需要进一步研究以确定CIN的最佳筛查方法。
