University of Michigan Medical Center, Ann Arbor, MI 48103, USA.
Am Fam Physician. 2013 Jun 15;87(12):836-43.
Women who have abnormal Papanicolaou test results may undergo colposcopy to determine the biopsy site for histologic evaluation. Traditional grading systems do not accurately assess lesion severity because colposcopic impression alone is unreliable for diagnosis. The likelihood of finding cervical intraepithelial neoplasia grade 2 or higher increases when two or more cervical biopsies are performed. Excisional and ablative methods have similar treatment outcomes for the eradication of cervical intraepithelial neoplasia. However, diagnostic excisional methods, including loop electrosurgical excision procedure and cold knife conization, are associated with an increased risk of adverse obstetric outcomes, such as preterm labor and low birth weight. Methods of endometrial assessment have a high sensitivity for detecting endometrial carcinoma and benign causes of uterine bleeding without unnecessary procedures. Endometrial biopsy can reliably detect carcinoma involving a large portion of the endometrium, but is suboptimal for diagnosing focal lesions. A 3- to 4-mm cutoff for endometrial thickness on transvaginal ultrasonography yields the highest sensitivity to exclude endometrial carcinoma in postmenopausal women. Saline infusion sonohysteroscopy can differentiate globally thickened endometrium amenable to endometrial biopsy from focal abnormalities best assessed by hysteroscopy. Hysteroscopy with directed biopsy is the most sensitive and specific method of diagnosing endometrial carcinoma, other than hysterectomy.
患有巴氏涂片检查结果异常的女性可能需要接受阴道镜检查，以确定活检部位进行组织学评估。传统的分级系统不能准确评估病变的严重程度，因为阴道镜检查的印象本身对于诊断是不可靠的。当进行两次或更多次宫颈活检时，发现宫颈上皮内瘤变 2 级或更高级别病变的可能性增加。切除和消融方法在消除宫颈上皮内瘤变方面具有相似的治疗效果。然而，诊断性切除方法，包括环形电切术和冷刀锥切术，与不良产科结局（如早产和低出生体重）的风险增加相关。子宫内膜评估方法对检测子宫内膜癌和良性子宫出血原因具有很高的敏感性，而不会进行不必要的检查。子宫内膜活检可以可靠地检测涉及大部分子宫内膜的癌，但对于诊断局灶性病变则不理想。经阴道超声检查中子宫内膜厚度的 3-4mm 截断值可在绝经后妇女中获得最高的敏感性，以排除子宫内膜癌。盐水灌注超声宫腔镜检查可以将可进行子宫内膜活检的全球增厚子宫内膜与宫腔镜最佳评估的局灶性异常区分开来。除了子宫切除术之外，宫腔镜联合定向活检是诊断子宫内膜癌最敏感和最特异的方法。
