Shah S, Montgomery H, Crow J C, Smith C J, Moore A, Sabin C A, Evans H, Johnson M A
Department of Primary Care, Royal Free and University College Medical Schools, London, UK.
J Obstet Gynaecol. 2008 Apr;28(3):327-32. doi: 10.1080/01443610802054964.
We set out to consider the level of agreement between referral and treatment pathology and to investigate the effectiveness of standard surgical treatment for cervical intraepithelial neoplasia (CIN) in Human Immunodeficiency Virus (HIV)-positive women. This was a case-note review of all women who underwent treatment for CIN between 1995 and 2004. Information on the referral and follow-up smear and biopsy results and the status of the excision margins at treatment were collected. A total of 71 women had at least one large loop excision of the transformation zone (LLETZ) for CIN. Agreement between the referral smear and biopsy was poor (kappa = 0.20) and between the referral and treatment pathology was only fair (kappa = 0.37). Ten treatment samples showed no histological evidence of CIN and were excluded from analysis of the presence of CIN at the resection margins. In only 32.8% of treatment samples were both margins clear of CIN. A high pre-LLETZ CD4 count was strongly associated with clear margins. A total of 55.6% patients had CIN at follow-up, despite both margins being clear. The follow-up smear/biopsy had decreased by >or=1 grade of CIN in only 50.8% patients. Our results show a high degree of discrepancy between cytology/biopsy and LLETZ histology in HIV-positive women. Additionally, there is often incomplete clearance of CIN at the resection margins emphasing the need for close follow-up after surgery.
我们着手研究转诊病理与治疗病理之间的一致性水平，并调查标准手术治疗对人类免疫缺陷病毒（HIV）阳性女性宫颈上皮内瘤变（CIN）的有效性。这是一项对1995年至2004年间接受CIN治疗的所有女性的病例记录回顾。收集了关于转诊和后续涂片及活检结果以及治疗时切缘状态的信息。共有71名女性因CIN至少接受了一次转化区大环形切除术（LLETZ）。转诊涂片与活检之间的一致性较差（kappa = 0.20），转诊与治疗病理之间的一致性仅为中等（kappa = 0.37）。10份治疗样本未显示CIN的组织学证据，因此被排除在切缘CIN存在情况的分析之外。仅32.8%的治疗样本切缘均无CIN。LLETZ术前CD4计数高与切缘阴性密切相关。尽管切缘均为阴性，但共有55.6%的患者在随访时仍有CIN。随访涂片/活检显示CIN级别降低≥1级的患者仅占50.8%。我们的结果表明，HIV阳性女性的细胞学/活检与LLETZ组织学之间存在高度差异。此外，手术切缘CIN常清除不完全，这强调了术后密切随访的必要性。
