Division of Gynecologic Oncology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Gynecol Oncol. 2013 Sep;130(3):421-5. doi: 10.1016/j.ygyno.2013.05.037. Epub 2013 Jun 5.
The aim of this study was to estimate cost and outcomes associated with colposcopy following abnormal Pap for women with a history of cervical cancer.
Decision models compared the costs and number of isolated local recurrences (ILR) detected using two strategies, colposcopy and no colposcopy, for women with a history of cervical cancer and low grade or high grade Pap. Clinical data for input were derived from a cohort of women with a history of cervical cancer undergoing surveillance Paps at 2 institutions. Costs were obtained using national reimbursement data.
Five hundred fifty-six patients underwent 2900 surveillance Paps. Twenty-seven of 50 women with a low grade Pap underwent colposcopy. One of 3 recurrences in the colposcopy group was an ILR diagnosed colposcopically. Colposcopy following low grade Pap costs $354 more and resulted in a lower rate of diagnosis of ILR compared to no colposcopy (3.7% vs 8.6%). Sixty of 78 women with a high grade Pap underwent colposcopy. Three of 15 recurrences in the colposcopy group were ILR diagnosed colposcopically. Colposcopy following high grade Pap costs $623 more than no colposcopy but resulted in a higher rate of diagnosis of ILR (5% vs 0%; $7481 per additional ILR).
Colposcopy following low or high grade surveillance Pap smear adds substantial cost to the management of women with cervical cancer. Only colposcopy following a high grade Pap is associated with a higher probability that cervical cancer recurrence will be detected when salvageable. These findings support withholding colposcopy for abnormal surveillance Pap tests less than high grade.
本研究旨在评估对宫颈癌病史患者巴氏涂片异常后行阴道镜检查的成本和结局。
决策模型比较了两种策略（阴道镜检查和无阴道镜检查）的成本和检测到的孤立局部复发（ILR）数量，这些策略用于治疗宫颈癌病史且巴氏涂片结果为低级别或高级别上皮内瘤变的女性。输入的临床数据来自在 2 家机构接受宫颈癌病史监测巴氏涂片的女性队列。成本使用国家报销数据获得。
556 名患者接受了 2900 次监测巴氏涂片检查。50 名低级别巴氏涂片异常的女性中有 27 名接受了阴道镜检查。阴道镜检查组的 3 次复发中有 1 次是经阴道镜诊断的 ILR。与无阴道镜检查相比，低级别巴氏涂片后行阴道镜检查的费用增加了 354 美元，但 ILR 的诊断率更低（3.7%比 8.6%）。78 名高级别巴氏涂片异常的女性中有 60 名接受了阴道镜检查。阴道镜检查组的 15 次复发中有 3 次是经阴道镜诊断的 ILR。高级别巴氏涂片后行阴道镜检查的费用比无阴道镜检查增加了 623 美元，但 ILR 的诊断率更高（5%比 0%；每增加一个 ILR 为 7481 美元）。
低级别或高级别监测巴氏涂片异常后行阴道镜检查会显著增加宫颈癌患者的管理成本。只有在高级别巴氏涂片异常后行阴道镜检查才能提高可挽救性宫颈癌复发的检出率。这些发现支持对低度异常监测巴氏涂片检查结果不进行阴道镜检查。
