Sharpless Kathryn E, Schnatz Peter F, Mandavilli Srinivas, Greene John F, Sorosky Joel I
Hartford Hospital, Hartford, Connecticut 06102, USA.
Obstet Gynecol. 2005 Mar;105(3):501-6. doi: 10.1097/01.AOG.0000153489.25288.c1.
We sought to estimate the rates and types of evaluation in women with atypical glandular cells of undetermined significance (AGC-US) on cervical cytology and to assess these findings on the basis of published management guidelines.
The rates of histologic sampling, comprehensive initial evaluations, and secondary evaluations were assessed in 477 women with an AGC-US Pap test from 1998 to 2001. A comprehensive evaluation was defined as a colposcopy and an endocervical curettage with or without a cervical biopsy. For women aged 35 or older, a comprehensive evaluation also included an endometrial biopsy. A secondary evaluation consisted of a diagnostic cone biopsy.
Sixty-four percent of women with an AGC-US Pap test had histologic sampling; 36% were followed by repeat Pap test only. Thirty-six percent of women with an AGC-US Pap test had a comprehensive evaluation. Women with an AGC-US Pap test that was subclassified as malignant-appearing had higher rates of histologic and comprehensive evaluations than women with a benign-appearing or unspecified AGC-US Pap test (P < .01). Twenty-eight percent of women aged 35 or older had comprehensive evaluations compared with 57% of women younger than the age of 35 (P < .01). Secondary evaluations were performed in 8% of women with persistent AGC-US Pap tests and 2% of women with malignant-appearing AGC-US Pap tests after negative initial histologic evaluations. Twelve of the 42 cases of disease (29%) were diagnosed more than 1 year from the initial AGC-US Pap test.
On the basis of accepted management guidelines, these data suggest that women with AGC-US Pap tests are undermanaged in both their initial and secondary evaluations.
我们试图评估宫颈细胞学检查显示意义不明确的非典型腺细胞（AGC-US）的女性的评估率及评估类型，并根据已发表的管理指南对这些结果进行评估。
对1998年至2001年间477例AGC-US巴氏试验的女性进行组织学采样率、全面初始评估率和二次评估率的评估。全面评估定义为阴道镜检查及宫颈管刮除术，可进行或不进行宫颈活检。对于35岁及以上的女性，全面评估还包括子宫内膜活检。二次评估包括诊断性锥形活检。
AGC-US巴氏试验的女性中，64%进行了组织学采样；36%仅接受了重复巴氏试验随访。AGC-US巴氏试验的女性中，36%进行了全面评估。AGC-US巴氏试验分类为疑似恶性的女性，其组织学和全面评估率高于巴氏试验表现为良性或未明确的女性（P <.01）。35岁及以上的女性中，28%进行了全面评估，而35岁以下的女性中这一比例为57%（P <.01）。在初始组织学评估为阴性后，持续AGC-US巴氏试验的女性中有8%进行了二次评估，疑似恶性AGC-US巴氏试验的女性中有2%进行了二次评估。42例疾病中有12例（29%）在首次AGC-US巴氏试验后1年以上才被诊断出来。
根据公认的管理指南，这些数据表明，AGC-US巴氏试验的女性在初始和二次评估中均未得到充分管理。
