Solomon Diane, Stoler Mark, Jeronimo Jose, Khan Michelle, Castle Philip, Schiffman Mark
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Obstet Gynecol. 2007 Aug;110(2 Pt 1):288-95. doi: 10.1097/01.AOG.0000270154.69879.09.
To estimate the diagnostic yield of endocervical curettage (ECC) when performed as part of a colposcopic procedure in the multicenter ASCUS-LSIL Triage Study (ALTS), a randomized trial of management strategies for women with equivocal or mildly abnormal cytology.
A total of 1,119 women in ALTS had colposcopic examinations that included an ECC performed at the discretion of the colposcopist. We compared the results of ECC and concurrent cervical colposcopic evaluation, with or without biopsy, in prediction of final histopathologic diagnosis. This was defined as the worst histopathologic result from that colposcopy or any subsequent procedure during 2 years of follow-up.
Overall, 3.7% of ECCs yielded a diagnostic abnormality of cervical intraepithelial neoplasia (CIN) 2+ compared with 21.7% of colposcopically directed biopsies. In women ultimately found to have CIN 2+ in the trial, the overall sensitivity of colposcopically directed biopsy was 72.5%, compared with 12.2% for ECC. In women under 40, the marginal contribution of ECC, independently of biopsy, was only 2.2%. By contrast, among women 40 and older, the sensitivity of biopsy dropped while the sensitivity of ECC improved, resulting in 13.0% increased detection with ECC, independently of biopsy. However, in women 40 and older, the combined sensitivity of ECC and biopsy was only 47.8% for a single colposcopy procedure.
As an ancillary diagnostic technique to colposcopically directed biopsy, ECC is of questionable value in younger women. However, in women aged 40 and older, the sensitivity of colposcopic biopsy decreased and the sensitivity of ECC increased. Thus, ECC may be useful in older women undergoing colposcopy for equivocal or mildly abnormal cytology.
在多中心非典型鳞状细胞意义不明确/低度鳞状上皮内病变分流研究（ALTS）中，评估作为阴道镜检查一部分进行的宫颈管搔刮术（ECC）的诊断率，该研究是一项针对细胞学检查结果不明确或轻度异常女性的管理策略随机试验。
ALTS中共有1119名女性接受了阴道镜检查，其中包括由阴道镜医生酌情进行的ECC。我们比较了ECC结果与同期宫颈阴道镜评估（无论有无活检）对最终组织病理学诊断的预测情况。最终组织病理学诊断定义为该阴道镜检查或2年随访期间任何后续手术的最差组织病理学结果。
总体而言，3.7%的ECC检查发现宫颈上皮内瘤变（CIN）2级及以上的诊断异常，而阴道镜引导下活检的这一比例为21.7%。在试验中最终被发现患有CIN 2级及以上的女性中，阴道镜引导下活检的总体敏感性为72.5%，而ECC为12.2%。在40岁以下的女性中，独立于活检之外，ECC的边际贡献仅为2.2%。相比之下，在40岁及以上的女性中，活检的敏感性下降，而ECC的敏感性提高，导致独立于活检之外，ECC的检测率提高了13.0%。然而，在40岁及以上的女性中，单次阴道镜检查时ECC和活检的联合敏感性仅为47.8%。
作为阴道镜引导下活检的辅助诊断技术，ECC在年轻女性中的价值存疑。然而，在40岁及以上的女性中，阴道镜活检的敏感性下降，ECC的敏感性增加。因此，ECC可能对因细胞学检查结果不明确或轻度异常而接受阴道镜检查的老年女性有用。
