Ihonor A O, Cheung W Y, Freites O N
Neath General Hospital, Singleton Hospital, Swansea, UK.
J Obstet Gynaecol. 1999 Mar;19(2):169-71. doi: 10.1080/01443619965534.
Findings on Papanicolaou (Pap) smear and colposcopically directed punch biopsy show discrepancies when compared with findings on loop excision specimens and this situation creates management problems. We performed a comparative assessment of cervical intraepithelial neoplasia (CIN) in 100 consecutive women who had large loop excision of the transformation zone (LLETZ) with a view to developing a local protocol that would be safe, avoid delay and minimise over-treatment. Agreement between Pap smear and LLETZ was 62% with 21% overcall and 17% undercall at Pap smear; there was no significant correlation (Spearman's rank correlation coefficient 0.17 P > 0.05). The agreement between punch biopsy and LLETZ was 61% with 25% overcall and 15% undercall at punch biopsy; there was a slight agreement over chance (kappa=0.20) and there was a weak but significant correlation (Spearman's rank correlation coefficient=0.26; P = 0.047). Colposcopic impression of 'highly abnormal'lesions agreed with high grade lesions on LLETZ in 83% of cases. The problem of undercall suggests that defaulters with apparent low grade dyskaryosis need to be pursued to colposcopy as vigorously as defaulters with high grade dyskaryosis. The lack of significant correlation between cervical cytology and LLETZ finding suggests that the smear-to-colposcopy waiting interval should not be strictly based on the degree of dyskaryosis.
巴氏涂片检查结果与阴道镜引导下的活检结果与环形切除标本的结果相比存在差异，这种情况带来了管理问题。我们对100名连续接受转化区大环形切除术（LLETZ）的女性进行了宫颈上皮内瘤变（CIN）的比较评估，以期制定一个安全、避免延误并尽量减少过度治疗的本地方案。巴氏涂片与LLETZ的一致性为62%，巴氏涂片检查时有21%的过度诊断和17%的漏诊；两者之间无显著相关性（斯皮尔曼等级相关系数为0.17，P>0.05）。活检与LLETZ的一致性为61%，活检时有25%的过度诊断和15%的漏诊；两者之间的一致性略高于随机水平（kappa=0.20），且存在弱但显著的相关性（斯皮尔曼等级相关系数=0.26；P=0.047）。阴道镜检查印象为“高度异常”的病变在83%的病例中与LLETZ上的高级别病变相符。漏诊问题表明，对于明显低级别核异质的未复诊者，应像对高级别核异质的未复诊者一样积极追查至阴道镜检查。宫颈细胞学检查与LLETZ结果之间缺乏显著相关性，这表明涂片到阴道镜检查的等待间隔不应严格基于核异质程度。
