Numnum T Michael, Kirby Tyler O, Leath Charles A, Huh Warner K, Alvarez Ronald D, Straughn J Michael
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35294-7333, USA.
J Low Genit Tract Dis. 2005 Jan;9(1):2-6. doi: 10.1097/00128360-200501000-00002.
The evaluation of abnormal cervical cytologic results is time consuming and costly. Most patients with high-grade squamous intraepithelial lesion (HSIL)-cervical intraepithelial neoplasia 3 (CIN 3) Pap smear results require an excisional procedure for diagnostic or therapeutic reasons. "See and treat" is a surgical procedure that involves a loop electrosurgical excisional procedure (LEEP) simultaneously to diagnose and to treat premalignant cervical disease in one visit. This procedure eliminates a second visit that typically is required for treatment. Data is lacking on the incidence of CIN 2 and CIN 3 in patients with an HSIL (CIN 2) Pap smear result. The objective of this study was to determine the incidence of CIN 2 and CIN 3 in patients with an HSIL (CIN 2) Pap smear using a see-and-treat protocol.
Women referred from local health departments to our university-based colposcopy clinic for evaluation of an HSIL (CIN 2) Pap smear result were evaluated for inclusion in a see and treat protocol. All eligible patients underwent colposcopy to rule out an obvious cervical carcinoma followed by an immediate LEEP to remove the transformation zone. A colposcopic impression was made using the Reid colposcopic index. Pathologic specimens were analyzed for the presence of CIN and the incidence of CIN 2 and CIN 3 was determined.
To date, 51 patients have been enrolled in the study. Exclusion criteria included age less than 19 years, pregnancy, or medical contraindications. The mean age of the patients was 26 years (range, 19-45 years). Forty-seven percent were white, 47% were black, and 6% were Hispanic. Of the 51 patients who underwent LEEP, 43 of 51 (85%) had satisfactory colposcopy and no patient had a lesion suspicious for cervical carcinoma. The average Reid colposcopic index was 3.5. Of the 51 LEEP specimens, 4 of 51 had no evidence of CIN (8%), 4 of 51 (8%) had CIN 1, 18 of 51 (35%) had CIN 2, and 25 of 51 (49%) had CIN 3. Eighty-four percent of patients had either CIN 2 or CIN 3, resulting in an overtreatment rate (CIN 1 or less) of 16%.
The use of a see and treat protocol for patients with HSIL (CIN 2) Pap smear results may be an acceptable treatment option because of a high incidence of CIN 2 and CIN 3.
评估异常宫颈细胞学检查结果既耗时又费钱。大多数高级别鳞状上皮内病变（HSIL）-宫颈上皮内瘤变3级（CIN 3）巴氏涂片结果的患者因诊断或治疗原因需要进行切除手术。“见病变即治疗”是一种外科手术，包括同时进行环形电切术（LEEP），以便在一次就诊中诊断和治疗宫颈癌前病变。该手术省去了通常所需的第二次治疗就诊。目前缺乏关于HSIL（CIN 2）巴氏涂片结果患者中CIN 2和CIN 3发病率的数据。本研究的目的是使用“见病变即治疗”方案确定HSIL（CIN 2）巴氏涂片结果患者中CIN 2和CIN 3的发病率。
将从当地卫生部门转诊至我校附属医院阴道镜诊所评估HSIL（CIN 2）巴氏涂片结果的女性纳入“见病变即治疗”方案进行评估。所有符合条件的患者均接受阴道镜检查以排除明显的宫颈癌，随后立即进行LEEP以切除转化区。使用Reid阴道镜指数做出阴道镜诊断印象。对病理标本进行CIN分析，并确定CIN 2和CIN 3的发病率。
迄今为止，已有51例患者纳入本研究。排除标准包括年龄小于19岁、妊娠或存在医学禁忌证。患者的平均年龄为26岁（范围19 - 45岁）。47%为白人，47%为黑人，6%为西班牙裔。在接受LEEP的51例患者中，51例中有43例（85%）阴道镜检查结果满意，且无患者有可疑宫颈癌病变。平均Reid阴道镜指数为3.5。在51份LEEP标本中，51例中有4例（8%）无CIN证据，51例中有4例（8%）为CIN 1，51例中有18例（35%）为CIN 2，51例中有25例（49%）为CIN 3。84%的患者患有CIN 2或CIN 3，导致过度治疗率（CIN 1或更低）为16%。
对于HSIL（CIN 2）巴氏涂片结果的患者，由于CIN 2和CIN 3的高发病率，使用“见病变即治疗”方案可能是一种可接受的治疗选择。
