University of Alaska Anchorage, Anchorage, Alaska, USA.
J Low Genit Tract Dis. 2011 Apr;15(2):98-104. doi: 10.1097/LGT.0b013e3181f356eb.
To estimate changes in clinical practice in a cervical cancer screening program after the American Society for Colposcopy and Cervical Pathology's issuance of 2006 consensus guidelines (2006CG) for managing abnormal Pap tests.
Screening and diagnostic procedure records were extracted from the operational database of a Centers for Disease Control and Prevention-funded cervical cancer screening program in Alaska. New software was developed to compare these records to the American Society for Colposcopy and Cervical Pathology algorithms. Of the 16 algorithms, 11 were encoded, and results of patients with abnormal Pap results in 2 study windows (cohort A: 2005-2006: n = 1,431; cohort B: October 2007 to September 2008: n = 1,369) were compared with 2006CG recommendations. Comparisons between the practices in the 2 study windows were made using the Fisher exact test.
Among adolescents with low-grade squamous intraepithelial lesion or atypical squamous cells of undetermined significance Pap results, 117 (48%) of 243 in cohort A were given colposcopies compared with 28 (23%) of 192 in cohort B (p < .0001). There was no difference in the rate of human papillomavirus testing between cohorts A and B (23% vs 26%, p = .449). Among adults with low-grade squamous intraepithelial lesion, 63 (16%) of 402 in cohort A were given repeat Pap tests instead of colposcopies compared with 25 (7%) of 367 in cohort B (p < .0001). Temporal compliance was significantly improved (p = .025), with 75% in cohort A and 91% in cohort B being graded as timely or early.
Clinical practice has moved toward 2006CG recommendations in this program, although gaps remain. This evaluation will be used to inform a compliance improvement program. The software can be easily modified as 2006CG evolves and can be ported to other algorithmic practice guidelines.
在美国阴道镜和宫颈病理学会（ASCCP）发布 2006 年异常巴氏试验管理共识指南（2006CG）后，评估子宫颈癌筛查计划中临床实践的变化。
从一个由美国疾病控制与预防中心资助的阿拉斯加子宫颈癌筛查计划的操作数据库中提取筛查和诊断程序记录。开发了新软件以将这些记录与 ASCCP 算法进行比较。在 16 个算法中，编码了 11 个算法，对 2 个研究窗口（队列 A：2005-2006 年：n=1431；队列 B：2007 年 10 月至 2008 年 9 月：n=1369）中异常巴氏试验结果的患者的结果进行了比较，并与 2006CG 建议进行了比较。使用 Fisher 精确检验比较两个研究窗口之间的实践差异。
在低级别鳞状上皮内病变或非典型鳞状细胞意义不明的巴氏试验结果为 ASC-US 的青少年中，队列 A 中 243 例中有 117 例（48%）进行了阴道镜检查，而队列 B 中 192 例中有 28 例（23%）（p<0.0001）。队列 A 和队列 B 之间人乳头瘤病毒检测率无差异（23%对 26%，p=0.449）。在低级别鳞状上皮内病变的成年人中，队列 A 中 402 例中有 63 例（16%）行重复巴氏试验而非阴道镜检查，而队列 B 中 367 例中有 25 例（7%）（p<0.0001）。时间依从性显著提高（p=0.025），队列 A 中有 75%，队列 B 中有 91%被评为及时或早期。
虽然仍存在差距，但该计划的临床实践已朝着 2006CG 建议的方向发展。该评估将用于为合规改进计划提供信息。随着 2006CG 的发展，该软件可以轻松修改，并可以移植到其他算法实践指南中。
