From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, St. Louis, Missouri; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, Alabama.
Obstet Gynecol. 2011 Sep;118(3):548-553. doi: 10.1097/AOG.0b013e3182271fdd.
To evaluate the utility of liquid-based cytology in detecting recurrent cervical cancer among treated cervical cancer patients.
A retrospective multi-institution study identified patients treated for cervical cancer from January 1, 2000, to November 1, 2009, through local cancer registries and patient databases. Patients were excluded if they lacked follow-up or treatment data.
In all, 4,167 cytology results from 929 women were identified. Of these, 626 (15%) Pap test results from 312 (34%) women were abnormal, including 296 atypical squamous cells of undetermined significance (ASC-US; 47%); 179 low-grade squamous intraepithelial lesions (LSIL; 29%), 59 atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H; 9%); 55 high-grade squamous intraepithelial lesions (HSIL; 9%); 14 atypical glandular cells (2%), and 23 favor neoplasia (4%). Abnormal Pap test results led to 201 colposcopies in 135 women. Only 45 women had cervical intraepithelial neoplasia (CIN) 2 or worse, 25 had CIN 3, and 12 had cancer. Only 5 of 475 (1%) women with ASC-US or LSIL had CIN 3. Cancer recurred in 147 women, with 12 (8.1%) detected by Pap test; all but one had Pap test results of ASC-H or worse. One patient with ASC-US and human papillomavirus had a visible lesion on return for assessment 2 months after Pap testing. Colposcopy for cytology less than HSIL without a visible lesion on examination did not detect any recurrence or CIN 3. When stratified by stage and institution, patients treated with radiation had a higher risk of abnormal Pap test results (P<.001).
A third of cervical cancer survivors will have abnormal cytology during follow-up, but in the absence of a visible lesion, those with ASC-US or LSIL can be followed without colposcopy unless abnormalities persist. Women with ASC-H, HSIL, and similar abnormalities deserve colposcopy.
II.
评估液基细胞学在检测已治疗宫颈癌患者中宫颈癌复发的应用价值。
一项回顾性多机构研究通过当地癌症登记处和患者数据库确定了 2000 年 1 月 1 日至 2009 年 11 月 1 日期间接受宫颈癌治疗的患者。如果患者缺乏随访或治疗数据，则将其排除在外。
共确定了 929 名女性的 4167 份细胞学检查结果。其中，626 份（15%）巴氏试验结果（来自 312 名（34%）女性）异常，包括 296 例非典型鳞状细胞意义不明确（ASC-US；47%）；179 例低度鳞状上皮内病变（LSIL；29%）、59 例非典型鳞状细胞，不能排除高级别鳞状上皮内病变（ASC-H；9%）、55 例高级别鳞状上皮内病变（HSIL；9%）、14 例不典型腺细胞（2%）和 23 例倾向于肿瘤（4%）。异常巴氏试验结果导致 135 名女性中的 201 次阴道镜检查。仅有 45 名女性患有 CIN 2 或更高级别病变，25 名患有 CIN 3，12 名患有癌症。仅 5 名 ASC-US 或 LSIL 女性患有 CIN 3。147 名女性癌症复发，其中 12 名（8.1%）通过巴氏试验检测到；除 1 例外，其余均为 ASC-H 或更高级别病变。1 名 ASC-US 合并人乳头瘤病毒患者在巴氏试验后 2 个月复诊时可见病变。对于细胞学低于 HSIL 且检查未见可见病变的患者，未发现任何复发或 CIN 3。按分期和机构分层，接受放疗的患者巴氏试验异常的风险更高（P<.001）。
三分之一的宫颈癌幸存者在随访期间细胞学检查结果异常，但在无可见病变的情况下，如果 ASC-US 或 LSIL 持续存在，可在不进行阴道镜检查的情况下进行随访。ASC-H、HSIL 和类似异常的女性需要进行阴道镜检查。
II。
