Zhang Songlin, Thomas Jaiyeola, Thibodeaux Joel, Bhalodia Ami, Abreo Fleurette
Department of Pathology, Louisiana State University Health Science Center, Shreveport, LA 71130, USA.
Cytojournal. 2011;8:9. doi: 10.4103/1742-6413.81773. Epub 2011 May 31.
The new 2009 ACOG guideline for cervical cytology screening changed the starting age to 21 years regardless of the age of onset of sexual intercourse. However, many recent studies have shown a dramatic increase in the incidence of cervical epithelial abnormalities among adolescents within the past two decades.
For this study, the reports of 156,342 cervical cytology were available of which 12,226 (7.8%) were from teenagers. A total of 192 teenagers with high grade intraepithelial lesion (HSIL) cervical cytology were identified. The ages ranged from 13 to 19 years with a mean of 17.7 years and a median of 18 years. Among them, 31.3% were pregnant, 12.0% were postpartum, and 13.5% were on oral contraceptive. Ninety-eight had prior cervical cytology.
The teenagers had statistically significant higher detection rates of overall abnormal cervical cytology (23.6% vs. 6.6%, P = 0), with 15.4% vs. 3.2% (P = 0) of low grade intraepithelial lesion (LSIL) and 1.8% vs. 1.0% (P = 2.56 × 10(-13) ) of HSIL compared to women ≥20 years. The teenage group had the highest abnormal cytology among all age groups. The LSIL/HSIL ratio was 8.5:1 for teenagers and 3.1:1 for women ≥20 years. A total of 131 teenagers had cervical biopsies within 12 months of the HSIL cytology, with diagnoses of 39 CIN 3, 1 VAIN 3, 15 CIN 2, 62 CIN 1, and 14 had a negative histology (CIN 0). Only in 19 of these 39 women, the CIN 2/3 lesion proved to be persistent.
We conclude that cytology screening of high risk teenagers is effective in detecting CIN 2/3 lesions. Moreover, treatment and careful follow-up can be realized.
2009年美国妇产科医师学会（ACOG）关于宫颈细胞学筛查的新指南将起始年龄改为21岁，不论初次性交年龄如何。然而，最近许多研究表明，在过去二十年中青少年宫颈上皮异常的发病率急剧上升。
在本研究中，可获取156,342份宫颈细胞学报告，其中12,226份（7.8%）来自青少年。共识别出192例高级别上皮内瘤变（HSIL）宫颈细胞学的青少年。年龄范围为13至19岁，平均年龄17.7岁，中位数为18岁。其中，31.3%为孕妇，12.0%为产后，13.5%正在服用口服避孕药。98例曾有过宫颈细胞学检查。
青少年总体宫颈细胞学异常检出率在统计学上显著高于≥20岁女性（23.6%对6.6%，P = 0），低级别上皮内瘤变（LSIL）分别为15.4%对3.2%（P = 0），HSIL分别为1.8%对1.0%（P = 2.56×10⁻¹³）。青少年组在所有年龄组中细胞学异常率最高。青少年的LSIL/HSIL比例为8.5:1，≥20岁女性为3.1:1。共有131例青少年在HSIL细胞学检查后的12个月内进行了宫颈活检，诊断结果为39例宫颈上皮内瘤变3级（CIN 3）、1例阴道上皮内瘤变3级（VAIN 3）、15例CIN 2、62例CIN 1，14例组织学检查为阴性（CIN 0）。在这39例女性中，只有19例CIN 2/3病变被证实持续存在。
我们得出结论，对高危青少年进行细胞学筛查可有效检测出CIN 2/3病变。此外，可实现治疗及仔细的随访。
