Walker Joan L, Wang Sophia S, Schiffman Mark, Solomon Diane
Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
Am J Obstet Gynecol. 2006 Aug;195(2):341-8. doi: 10.1016/j.ajog.2006.02.047.
At present, clinical management of women referred to colposcopy but found to have <CIN2 remains unclear. Using data from the ASCUS-LSIL Triage Study (ALTS) to inform clinical management, we calculated the absolute risk for developing CIN3 within 2 years of referral to an enrollment colposcopy.
Women included in the analyses: (1) were initially referred to ALTS with a community cytologic interpretation of atypical squamous cell of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL); (2) had a colposcopic evaluation and biopsy, if indicated, resulting in a diagnosis <CIN2; and, therefore (3) were followed without treatment. Results from subsequent human papillomavirus (HPV) testing, liquid-based cytology interpretations, and a second colposcopic evaluation at least 6 months after and within 2 years of the first colposcopic evaluation were used to calculate absolute risks for CIN3.
Women with HPV-negative test results were at low risk for CIN3 regardless of other test results. Among HPV-positive women, increasing absolute risks of CIN3 were observed with increasing cytology severity: 7% (normal), 11% (ASCUS and LSIL), and 45% (HSIL). The highest absolute risk for CIN3 (67%) was observed for HPV-positive women with HSIL and a colposcopic impression of high-grade/cancer on the second colposcopy.
In the ALTS population, after the first colposcopic diagnosis of <CIN2, clear risk stratification for CIN3 outcomes was obtained among women with a subsequent HPV-positive test. Because absolute risk for histologic CIN3 outcomes was high for women with HPV positive tests, HSIL cytology, and a high-grade impression at second colposcopy, it is worth considering whether this combination of findings might warrant immediate excisional therapy in some circumstances.
目前，对于转诊至阴道镜检查但被诊断为<CIN2的女性，其临床管理尚不明确。利用非典型鳞状细胞意义不明确（ASCUS）/低级别鳞状上皮内病变（LSIL）分流研究（ALTS）的数据指导临床管理，我们计算了转诊至入组阴道镜检查后2年内发展为CIN3的绝对风险。
纳入分析的女性：（1）最初因社区细胞学检查结果为非典型鳞状细胞意义不明确（ASCUS）或低级别鳞状上皮内病变（LSIL）而被转诊至ALTS；（2）接受了阴道镜评估及必要的活检，诊断结果为<CIN2；因此（3）未接受治疗而接受随访。后续的人乳头瘤病毒（HPV）检测结果、液基细胞学检查结果以及首次阴道镜检查后至少6个月且在2年内进行的第二次阴道镜评估结果被用于计算CIN3的绝对风险。
HPV检测结果为阴性的女性，无论其他检测结果如何，发生CIN3的风险都较低。在HPV阳性的女性中，随着细胞学严重程度的增加，CIN3的绝对风险也在增加：正常为7%，ASCUS和LSIL为11%，高级别鳞状上皮内病变（HSIL）为45%。对于HPV阳性且第二次阴道镜检查有高级别/癌症阴道镜印象的HSIL女性，观察到CIN3的最高绝对风险（67%）。
在ALTS人群中，首次阴道镜诊断为<CIN2后，后续HPV检测呈阳性的女性中获得了明确的CIN3结局风险分层。由于HPV检测呈阳性、HSIL细胞学检查结果以及第二次阴道镜检查有高级别印象的女性发生组织学CIN3结局的绝对风险较高，因此值得考虑在某些情况下，这种综合结果是否可能需要立即进行切除治疗。
