巴氏涂片筛查子宫颈小细胞癌：病例系列及文献复习。
Pap smear screening for small cell carcinoma of the uterine cervix: a case series and review of the literature.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
出版信息
J Gynecol Oncol. 2011 Mar 31;22(1):39-43. doi: 10.3802/jgo.2011.22.1.39.
OBJECTIVE
Small cell carcinoma of the uterine cervix (SMCC) is extremely rare, and an aggressive disease that proliferates rapidly. It was often reported that the diagnostic accuracy of cytologic smears in diagnosing SMCC was low. This is a report of the Severance Hospital experience with the patients suffering from SMCC.
METHODS
Twenty-seven patients with small cell carcinoma of the uterine cervix were diagnosed and treated at the Severance Hospital from November 1991 to January 2010. The data were analyzed retrospectively, based on the available charts and pathology reports. Various fields, such as chief complaints and symptoms present at first clinic visit, age, International Federation of Obstetrics and Gynecology (FIGO) clinical stage, treatment modality, the 5-year overall survival rate, and recurrence rate were investigated.
RESULTS
Among the 27 patients diagnosed with small cell carcinoma of the uterine cervix, 18 of them (66.7%) presented with symptoms, including vaginal bleeding, at the first clinic visit, and the remaining 9 patients (33.3%) showed abnormal Pap smear screening in the process of their routine health check-up. The median age of the patients was 54 years (range, 24 to 77 years). FIGO stage IIB was the most common stage (11 of 27 patients). The 5-year overall survival rate of 21 patients, who could be followed up, was 57.2%. Six patients showed recurrence after remission, and the mean disease free interval of them was 9.2 months (range, 6 to 11 months). Abnormal Pap smear screening results of 9 patients was investigated, and the diagnostic accuracy of the cytologic findings was 22.2%.
CONCLUSION
Our study was consistent with the concept that Pap smear screening might not be helpful in early diagnosis of SMCC considering its low diagnostic accuracy. Further large-scale multicenter prospective studies are definitely needed in order to produce abundant information about optimal therapy and diagnosis.
目的
子宫颈小细胞癌（SMCC）极为罕见，是一种增殖迅速的侵袭性疾病。据报道，细胞学涂片在诊断 SMCC 中的准确性较低。本文报告了首尔峨山医院治疗 SMCC 患者的经验。
方法
1991 年 11 月至 2010 年 1 月，在首尔峨山医院诊断并治疗了 27 例子宫颈小细胞癌患者。回顾性分析了基于现有图表和病理报告的资料。调查了主要症状和体征、初诊年龄、国际妇产科联合会（FIGO）临床分期、治疗方式、5 年总生存率和复发率等。
结果
27 例子宫颈小细胞癌患者中，18 例（66.7%）初诊时有症状，包括阴道出血，9 例（33.3%）在常规健康检查中出现异常巴氏涂片筛查。患者的中位年龄为 54 岁（范围：24 岁至 77 岁）。FIGO 分期 IIB 最常见（27 例中的 11 例）。21 例可随访患者的 5 年总生存率为 57.2%。6 例缓解后复发，无病间隔时间的平均值为 9.2 个月（范围：6 个月至 11 个月）。对 9 例异常巴氏涂片筛查结果进行了调查，细胞学检查的诊断准确率为 22.2%。
结论
我们的研究结果与巴氏涂片筛查可能无助于 SMCC 的早期诊断的概念一致，考虑到其较低的诊断准确性。为了获得关于最佳治疗和诊断的丰富信息，肯定需要进行更大规模的多中心前瞻性研究。
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