Siebers A G, Massuger L F A G, Bulten J
Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Cytopathology. 2007 Apr;18(2):96-104. doi: 10.1111/j.1365-2303.2007.00427.x.
Borderline cytological abnormalities are diagnosed very frequently but have limited predictive value for high-grade cervical lesions, resulting in high costs, patient anxiety and over treatment. A conservative management strategy for the Dutch diagnostic equivalent of borderline nuclear changes (BNC) was introduced in the Netherlands in 1996, with repeat cytology at 6 and 18 months and referral for colposcopy if BNC is persistent.
To analyse compliance with the current guidelines for referral, as well as the outcome after repeated BNC. Concurrently we investigated whether other variables are predictive of high-grade lesions.
We retrieved 1898 eligible cases of repeated BNC with 4 years follow-up from the national pathology database (PALGA) and performed a nationwide survey.
The management strategy for women with repeated BNC in the Netherlands has been accepted and supported. Seventy-seven per cent (77%) of the patients had visited a gynaecologist within 1 year and only 4.3% were lost to follow-up. We found that 25.2% of the patients had a low-grade lesion or worse (CIN 1+) and 10.2% had a high-grade lesion or worse (CIN 2+), among which were four malignancies. The only variable associated with CIN or worse was age. Women under 40 years were found to be at a higher risk.
This finding may be used for prioritizing women for colposcopy on the basis of their age. More stringent use of the diagnosis of BNC, higher thresholds for colposcopically directed biopsy and introduction of HPV triage, combined with more specific new techniques or combination of techniques such as molecular markers for P16, MIB-1 and L1 may reduce the unnecessary high referral rate and over treatment of healthy women.
临界细胞学异常诊断频繁，但对高级别宫颈病变的预测价值有限，导致成本高昂、患者焦虑和过度治疗。1996年荷兰引入了针对荷兰诊断相当于临界核改变（BNC）的保守管理策略，在6个月和18个月时重复进行细胞学检查，若BNC持续存在则转诊进行阴道镜检查。
分析对当前转诊指南的依从性以及重复出现BNC后的结果。同时，我们调查了其他变量是否可预测高级别病变。
我们从国家病理数据库（PALGA）中检索了1898例符合条件的重复BNC病例，并进行了4年随访，同时开展了一项全国性调查。
荷兰针对重复出现BNC的女性的管理策略已被接受和支持。77%的患者在1年内看了妇科医生，只有4.3%失访。我们发现，25.2%的患者有低级别病变或更严重病变（CIN 1+），10.2%有高级别病变或更严重病变（CIN 2+），其中有4例为恶性肿瘤。与CIN或更严重病变相关的唯一变量是年龄。发现40岁以下女性风险更高。
这一发现可用于根据年龄对女性进行阴道镜检查的优先排序。更严格地使用BNC诊断、提高阴道镜引导活检的阈值以及引入HPV分流，再结合更具特异性的新技术或技术组合，如P16、MIB-1和L1的分子标志物，可能会降低健康女性不必要的高转诊率和过度治疗。
