Howell Lydia P, Tabnak Farzaneh, Tudury A J, Stoodt Georjean
Department of Pathology, Davis School of Medicine, University of California, Davis, California, USA.
Diagn Cytopathol. 2004 Apr;30(4):227-34. doi: 10.1002/dc.10306.
Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995-December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities.
我们的目标是评估按照贝塞斯达系统分类的巴氏试验结果，并对参加加利福尼亚州乳腺癌和宫颈癌控制项目（Ca - BCCCP）的参与者的活检进行随访，以：1）原位癌（CIS）和浸润癌（CI）检测的相关性，以及2）年龄相关趋势，并结合2001年美国阴道镜及子宫颈病理学会（ASCCP）管理指南进行讨论。对1995年1月至1999年12月间在Ca - BCCCP进行首次筛查巴氏试验的女性（n = 52,339）进行随访，直至2000年12月的诊断服务。分析中采用了描述性和分析性方法。在巴氏试验结果中，81.9%为阴性，10.6%显示感染，4.7%显示贝塞斯达系统定义的上皮异常（意义不明确的非典型鳞状细胞（ASCUS）、低级别鳞状上皮内病变（LSIL）或高级别鳞状上皮内病变（HSIL）），0.1%显示鳞状细胞癌（SCC），2.7%显示其他或不满意结果。在首次巴氏试验之后，原位癌（CIS）和浸润癌（CI）的随访结果分别占总人群的0.36%和0.05%。在HSIL巴氏试验（n = 285）中，40.7%的随访显示为CIS。在SCC巴氏试验中，17.9%的随访结果为CIS，28.6%为CI。在191例随访发现为CIS的患者中，最初的巴氏涂片显示：HSIL占60.7%，SCC占2.6%，LSIL占10.5%，ASCUS占13.6%，阴性或感染占9.9%。在27例CI患者中，最初的巴氏试验显示：HSIL占40.7%，SCC占29.6%，LSIL占7.4%，ASCUS占7.4%，阴性或感染占11.1%。其他或不满意的巴氏诊断在CIS患者的巴氏结果中占2.6%，在CI患者的巴氏结果中占3.7%。除LSIL外，各巴氏结果中的病例数均呈现年龄增长趋势，但65岁及以上年龄组除外。然而，LSIL和ASCUS与阴性病例的比例随年龄下降。（分别为P < 0.0001和0.0293）。HSIL巴氏结果表明CIS和CI的可能性相当高。然而，约1/3的CIS患者和1/4的CI患者最初的巴氏诊断严重程度低于HSIL。当将阴性巴氏试验结果作为参照组时，LSIL和ASCUS呈现负年龄趋势，其他结果无年龄趋势。这些发现对随访策略的设计均具有重要意义，并支持2001年ASCCP关于宫颈异常女性管理的共识指南。
