Castanon A, Ferryman S, Patnick J, Sasieni P
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Cytopathology. 2012 Feb;23(1):13-22. doi: 10.1111/j.1365-2303.2011.00948.x.
To audit pathology slide reporting in the Cervical Screening Programme in England by reviewing cytology and histology slides from women subsequently diagnosed with invasive cervical cancer.
Between April 2007 and March 2010, 6113 women diagnosed with cervical cancer were identified. Cervical cytology and histology slides taken within 10 years of diagnosis were identified and where possible reviewed after a nationally agreed protocol. Reviewers were not blinded to the original reading of each sample. Most cytology samples before 2005 were conventional, most after 2007 liquid based.
Of 13,745 cytology results from women developing cervical cancer, 55% were reviewed. The review result was identical for 55% of slides. Of 3759 originally normal slides, only 45% were normal on review: 11% were inadequate, 21% low grade (borderline or mild dyskaryosis) and 23% high grade (moderate dyskaryosis or worse). Of tests originally normal taken over 5.5 years before diagnosis, 14% were upgraded to high grade compared with 37% within 3.5 years of diagnosis. Of 5159 histology specimens recorded within 10 years of diagnosis of a cancer, 3895 were reviewed. Overall, 94% of samples reviewed retained the original diagnosis. One per cent (33/3012) of cancers were downgraded and 5% (6/112) of negative samples were upgraded to cancer upon review (four of which were taken within 2 months of diagnosis). In comparison, 15% (14/91) of cervical glandular intraepithelial neoplasia (CGIN) and 12% (38/314) of cervical intraepithelial neoplasia grade 3 (CIN3) were upgraded to cancer.
In spite of the excellent quality of cytology in England, a high proportion of negative cytology taken up to three and a half years before diagnosis were considered to contain abnormal cells by reviewers informed of the subsequent cancer. Continuing these reviews, with a strong focus on education, will ensure a clear understanding of these slides and further reduce the risk of developing cervical cancer.
通过回顾随后被诊断为浸润性宫颈癌的女性的细胞学和组织学切片，审核英格兰宫颈癌筛查计划中的病理切片报告。
在2007年4月至2010年3月期间，识别出6113名被诊断为宫颈癌的女性。确定在诊断前10年内采集的宫颈细胞学和组织学切片，并尽可能按照国家商定的方案进行复查。复查人员知晓每个样本的原始判读结果。2005年之前的大多数细胞学样本是传统涂片，2007年之后的大多数是液基涂片。
在患宫颈癌女性的13745份细胞学结果中，55%进行了复查。55%的切片复查结果与原结果一致。在3759份原结果正常的切片中，复查时只有45%仍为正常：11%为不满意切片，21%为低级别（临界或轻度核异质），23%为高级别（中度核异质或更严重）。在诊断前超过5.5年采集的原结果正常的检测中，14%被升级为高级别，而在诊断后3.5年内采集的检测中这一比例为37%。在癌症诊断后10年内记录的5159份组织学标本中，3895份进行了复查。总体而言，94%的复查样本维持原诊断。1%（33/3012）的癌症被降级，5%（6/112）的阴性样本复查时被升级为癌症（其中4份是在诊断后2个月内采集的）。相比之下，15%（14/91）的宫颈腺上皮内瘤变（CGIN）和12%（38/314）的宫颈上皮内瘤变3级（CIN3）被升级为癌症。
尽管英格兰的细胞学质量很高，但对于在诊断前三年半内采集的阴性细胞学样本，被告知后续癌症情况的复查人员认为其中很大一部分含有异常细胞。持续进行这些复查，并高度重视教育，将确保对这些切片有清晰的理解，并进一步降低患宫颈癌的风险。
