Luesley David, Downey Gabrielle
Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK.
J Low Genit Tract Dis. 2009 Jan;13(1):33-7. doi: 10.1097/LGT.0b013e3181839645.
Colposcopy is a secondary screening test used after a cytological specimen is reported as abnormal. A negative or normal colposcopy is not an infrequent outcome, and clinicians need to be aware of the clinical value of a normal and satisfactory colposcopic assessment.To address this problem, the underlying causes need to be fully understood. To this end, we have analyzed a retrospective dataset relating to new referrals to an urban colposcopy service.
We have reviewed 1,927 consecutive new colposcopic attendances during a 4-year period (1996-2000). Of these cases, 1,589 (82.4%) had documented satisfactory colposcopy in that the whole transformation zone was identified, and any lesion seen within it was suitable for outpatient-directed biopsy. These cases form the basis of this dataset. Seven hundred seventy-one colposcopies were classified as normal (48%).
The presenting smear was atypical squamous cells of undetermined significance (ASCUS) (41.3%), high-grade squamous intraepithelial lesion (HiSIL) (42.2%), low-grade squamous intraepithelial lesion (LoSIL) (13.1%), and unsatisfactory in 3.4%. One hundred five patients (13.6%) eventually underwent loop diathermy excision (loop electrocautery excision procedure). The indications to treat were as follows: a high-grade smear (N=31; 29.5%), a colposcopic suspicion of any cervical intraepithelial neoplasia in the presence of any smear result (N=35; 33%), or a persisting minor cytological abnormality (N=39; 37%). Patients were treated either at their first visit if they had a high-grade smear or up to the 10th visit. Forty-eight (45%) of the treated patients had high-grade disease. No cases of invasive disease were recorded.
Normal colposcopy in the presence of a low-grade cervical smear is associated with a very low risk of having or developing high-grade disease. The negative predictive value of normal colposcopy is a valuable clinical utility and underpins the importance of appropriate colposcopic training and the development of competencies that enable the confident exclusion of dysplasia.
阴道镜检查是在细胞学标本报告异常后使用的二级筛查测试。阴道镜检查结果为阴性或正常并不罕见，临床医生需要了解正常且满意的阴道镜评估的临床价值。为解决这一问题，需要充分了解其潜在原因。为此，我们分析了一组与城市阴道镜服务新转诊病例相关的回顾性数据集。
我们回顾了4年期间（1996 - 2000年）连续的1927例新的阴道镜检查病例。在这些病例中，1589例（82.4%）记录了满意的阴道镜检查，即识别出了整个转化区，且其中发现的任何病变都适合门诊定向活检。这些病例构成了该数据集的基础。771例阴道镜检查被分类为正常（48%）。
送检涂片结果为意义不明确的非典型鳞状细胞（ASCUS）（41.3%）、高级别鳞状上皮内病变（HiSIL）（42.2%）、低级别鳞状上皮内病变（LoSIL）（13.1%），不满意结果占3.4%。105例患者（13.6%）最终接受了环形电切术（环形电灼切除术）。治疗指征如下：高级别涂片（N = 31；29.5%）、在任何涂片结果下阴道镜怀疑有任何宫颈上皮内瘤变（N = 35；33%）或持续存在轻微细胞学异常（N = 39；37%）。如果患者有高级别涂片，在首次就诊时接受治疗；否则最多在第10次就诊时接受治疗。48例（45%）接受治疗的患者患有高级别疾病。未记录到浸润性疾病病例。
在低级别宫颈涂片情况下，阴道镜检查正常与发生或发展为高级别疾病的风险非常低相关。阴道镜检查正常的阴性预测价值是一项有价值的临床效用，这突出了适当的阴道镜培训以及培养能够自信排除发育异常的能力的重要性。
