Howell Lydia Pleotis, Gurusinghe Sunitha, Tabnak Farzaneh
Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California 95817, USA.
Diagn Cytopathol. 2009 Feb;37(2):103-10. doi: 10.1002/dc.20965.
In this study we evaluated CDP: EWC, a large public health screening program for low-income women to determine whether the ASC-H term, introduced in the 2001 revision to the Bethesda System, has facilitated the detection of the most serious precancerous cervical lesions such as CIN-II-III/CIS, including accuracy of detection and minimizing diagnostic delays. Pap test and biopsy data from the period 2003-2006 were compared with those from 1995-1999, and included analysis of a subset of rarely and never-screened for each study period. More ASC-H Pap tests were followed by CIN-II+ biopsies (20%) than ASCUS Pap tests (5%). Thirteen percent of ASC-H showed CIN-III/CIS on follow-up biopsy. Following the introduction of ASC-H, negative and LSIL Pap tests followed by CIN-III/CIS biopsies decreased from 5.6% to 0.37% and 9.2% to 4.4%, respectively. Fewer CIN-III/CIS cases were preceded by Pap tests with negative and ASCUS results in 2003-2005 as compared with 1995-1999. The number of days from screening to diagnosis for women aged 25-39 years with ASC-H Pap test results (58 days) was less than for ASCUS results (78 days) for the current study period. In this high-risk multi-ethnic population, ASC-H more effectively communicates equivocal findings likely to represent HSIL leading to more rapid follow-up. The incidence of CIN-II or CIN-III/CIS following ASC-H Pap tests is lower than generally appreciated for this population, including for rarely or never-screened high-risk women. Fewer CIN-III/CIS lesions were detected following negative and ASCUS Pap results. Compliance with follow-up is less than ideal for this population.
在本研究中，我们评估了针对低收入女性的大型公共卫生筛查项目CDP: EWC，以确定2001年修订的贝塞斯达系统中引入的ASC-H术语是否有助于检测最严重的宫颈癌前病变，如CIN-II-III/CIS，包括检测准确性和尽量减少诊断延迟。将2003 - 2006年期间的巴氏试验和活检数据与1995 - 1999年的数据进行比较，并且对每个研究期间很少筛查或从未筛查的一个子集进行了分析。与ASCUS巴氏试验（5%）相比，更多的ASC-H巴氏试验之后进行了CIN-II+活检（20%）。13%的ASC-H在后续活检中显示为CIN-III/CIS。引入ASC-H之后，随后进行CIN-III/CIS活检的阴性和LSIL巴氏试验分别从5.6%降至0.37%，从9.2%降至4.4%。与1995 - 1999年相比，2003 - 2005年期间CIN-III/CIS病例之前巴氏试验结果为阴性和ASCUS的情况较少。在本研究期间，25 - 39岁ASC-H巴氏试验结果的女性从筛查到诊断的天数（58天）少于ASCUS结果的女性（78天）。在这个高危多民族人群中，ASC-H更有效地传达了可能代表HSIL的模棱两可的结果，从而导致更快的后续跟进。ASC-H巴氏试验之后CIN-II或CIN-III/CIS的发生率低于该人群通常所认为的，包括很少或从未筛查的高危女性。阴性和ASCUS巴氏试验结果之后检测到的CIN-III/CIS病变较少。该人群对后续跟进的依从性不太理想。
