Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20892-7234, USA.
J Low Genit Tract Dis. 2013 Apr;17(2):137-41. doi: 10.1097/LGT.0b013e3182630c41.
No evidence-based clinical management recommendations exist for women with an endocervical curettage (ECC) cervical intraepithelial neoplasia grade 1 (CIN 1) result when the concurrent cervical biopsy is not high-grade. For women with these pathologic findings, we assessed their short-term risk of high-grade histopathologic diagnosis in the Calgary Health Region where ECC was routinely performed.
We analyzed pathology and colposcopy reports from 1,902 referral colposcopies where both ECC and biopsies were normal or CIN 1. We calculated the short-term risk of CIN 2 or more severe (CIN 2+) detected 12 to 24 months after colposcopy. Pearson χ tests or Fisher exact tests were used to compare risks of a CIN 2+ diagnosis between combinations of test results and strata of risk factors.
The short-term risk of CIN 2+ was the same after a CIN 1 biopsy and CIN 1 ECC (4.9% of 1,389 vs 5.0% of 359, respectively, p = .37). Compared with low-grade referral cytology, the risk of CIN 2+ after high-grade cytology was elevated significantly for CIN 1 ECC (13.3% vs 3.3%, p < .01) and nonsignificantly for CIN 1 biopsy (7.1% vs 4.6%, p = .12).
After low-grade cytology, the short-term risk of a high-grade histologic diagnosis in women with either CIN 1 ECC or biopsy is equivalent, suggesting similar management. A CIN 1 ECC may warrant different management in the context of high-grade referral cytology.
对于宫颈活检未见高级别病变的宫颈内膜上皮内瘤变 1 级（CIN1）患者，目前尚无基于循证的临床管理推荐意见。对于这些病理发现的患者，我们评估了她们在卡尔加里卫生区（常规行内膜刮宫术）短期内出现高级别组织学诊断的风险。
我们分析了 1902 例转诊阴道镜检查的病理和阴道镜报告，这些患者的内膜刮宫术和活检均正常或为 CIN1。我们计算了阴道镜检查后 12 至 24 个月内 CIN2 或更高级别病变（CIN2+）的短期风险。使用 Pearson χ 检验或 Fisher 确切概率检验比较不同检查结果组合和危险因素分层之间的 CIN2+诊断风险。
CIN1 活检和内膜刮宫术的 CIN2+短期风险相同（1389 例中为 4.9%，359 例中为 5.0%，p=.37）。与低级别转诊细胞学相比，高级别细胞学患者的 CIN2+风险显著升高，内膜刮宫术（13.3% vs. 3.3%，p <.01），活检（7.1% vs. 4.6%，p=.12）无显著升高。
低级别细胞学检查后，内膜刮宫术或活检诊断为 CIN1 的患者短期内出现高级别组织学诊断的风险相当，提示管理方法相似。在高级别转诊细胞学的情况下，内膜刮宫术可能需要不同的管理。
