Kirby A J, Spiegelhalter D J, Day N E, Fenton L, Swanson K, Mann E M, Macgregor J E
MRC Biostatistics Unit, Cambridge, UK.
Lancet. 1992 Apr 4;339(8797):828-31. doi: 10.1016/0140-6736(92)90278-b.
There is some controversy about the management of women with mild or moderate dyskaryotic cervical smears. To assess the strategy of an established cervical cytology screening programme (Grampian region, northeast Scotland) we identified 500 women who had had mild or moderate cervical dyskaryosis in 1978 or 1979, and 500, matched by age, who had had a normal smear at that time. Follow-up smear results and any subsequent investigation by colposcopy, cone biopsy, or hysterectomy, with biopsy result were recorded. Of the 500 women who initially had an abnormal smear, 300 (60%) had a smear that was normal or inflammatory at their last visit (after seven years' median follow-up). 184 (37%) had undergone biopsy, 97 (19%) of whom were cervical intraepithelial neoplasia grade III or worse. Survival curves for time to biopsy and ten-year biopsy rates show that women with an abnormal smear before their baseline year were the most likely to have a subsequent biopsy. Older women had a biopsy less often and at biopsy were more likely to have minor abnormalities. Mild or moderate dyskaryotic smears should not be an indication for immediate referral for colposcopy, since under a conservative management policy most women return to normal without needing treatment. Nevertheless, the increased risk associated with abnormal smears justifies rigorous surveillance.
对于轻度或中度细胞核异常的宫颈涂片检查结果的女性患者，其管理存在一些争议。为了评估一项既定的宫颈细胞学筛查计划（苏格兰东北部格兰扁地区）的策略，我们确定了500名在1978年或1979年有轻度或中度宫颈细胞异常的女性，以及500名年龄匹配、当时宫颈涂片检查结果正常的女性。记录随访涂片结果以及随后通过阴道镜检查、锥形活检或子宫切除术进行的任何检查及其活检结果。在最初涂片异常的500名女性中，300名（60%）在最后一次随访时（中位随访7年后）涂片结果正常或为炎症。184名（37%）接受了活检，其中97名（19%）为宫颈上皮内瘤变III级或更严重。活检时间的生存曲线和十年活检率表明，基线年份之前涂片异常的女性最有可能接受后续活检。老年女性活检的频率较低，且活检时更有可能出现轻微异常。轻度或中度细胞核异常的涂片不应成为立即转诊进行阴道镜检查的指征，因为在保守管理策略下，大多数女性无需治疗即可恢复正常。然而，与异常涂片相关的风险增加证明了进行严格监测的合理性。
