Karimi Zarchi Mojgan, Binesh Fariba, Kazemi Zohre, Teimoori Soraya, Soltani Hamid Reza, Chiti Zohre
Gynecology Oncology Department, Shahid Sadoughi University of Medical Science, Yazd, Iran.
Asian Pac J Cancer Prev. 2011;12(12):3439-41.
Cervical cancer is preventable, although it is common in developing countries and Iran, where there is no defined approach to "atypical squamous cells of undetermined significance" (ASCUS) on Pap smears. This study determined the value of colposcopy in the early diagnosis of cervix cancer in females with ASCUS.
This accuracy study examined 213 ASCUS cases referred from different cities from 2007 to 2009. All patients underwent a repeated conventional Pap smear, colposcopy, endocervical curettage, and a cervical biopsy, considered the gold-standard diagnostic test.
There was no significant relationship between age, age of first intercourse, smoking, or number of children and a positive cervical biopsy. The sensitivity and specificity of a repeat Pap smear for ASCUS were 15 and 93%, respectively, while the respective values for diagnosing cervical cancer with colposcopy were 80 and 80%. Endocervical curettage had 64% sensitivity and 100% specificity for diagnosing cervical cancer, and 11 positive neoplastic or malignant lesions reported on endocervical curettage were confirmed by biopsy.
Based on the low accuracy of the Pap smear in Iran as a developing country and the need for an early diagnosis of cervical cancer, a cervical biopsy and colposcopy are recommended for these patients. Colposcopy and endocervical curettage alone are better diagnostic tools than a repeat Pap smear for unsatisfactory Pap smears.
宫颈癌是可预防的，尽管在发展中国家和伊朗较为常见，在这些地方，巴氏涂片检查中对于“意义不明确的非典型鳞状细胞”（ASCUS）没有明确的处理方法。本研究确定了阴道镜检查在ASCUS女性宫颈癌早期诊断中的价值。
这项准确性研究检查了2007年至2009年从不同城市转诊来的213例ASCUS病例。所有患者均接受了重复的传统巴氏涂片检查、阴道镜检查、宫颈管刮术以及宫颈活检，宫颈活检被视为金标准诊断测试。
年龄、初次性交年龄、吸烟情况或子女数量与宫颈活检阳性之间无显著关系。重复巴氏涂片检查对ASCUS的敏感性和特异性分别为15%和93%，而阴道镜检查诊断宫颈癌的相应值分别为80%和80%。宫颈管刮术诊断宫颈癌的敏感性为64%，特异性为100%，宫颈管刮术报告的11例阳性肿瘤性或恶性病变经活检得到证实。
基于伊朗作为发展中国家巴氏涂片检查准确性较低以及宫颈癌早期诊断的必要性，建议对这些患者进行宫颈活检和阴道镜检查。对于不满意的巴氏涂片，单独的阴道镜检查和宫颈管刮术比重复巴氏涂片检查是更好的诊断工具。
