Wu Yu-Mei, Wang Tong, He Yue, Song Fang, Wang Yan, Zhu Li, Kong Wei-Min, Duan Wei, Zhang Wei-Yuan
Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100006, China,
Arch Gynecol Obstet. 2014 May;289(5):1071-7. doi: 10.1007/s00404-013-3076-5. Epub 2013 Nov 7.
To evaluate the clinical management of cervical intraepithelial neoplasia (CIN) and cervical microinvasive squamous cell carcinoma in pregnant and postpartum women.
This prospective study enrolled 27,230 pregnant women undergoing routine gestational examinations between August 1, 2007 and July 31, 2010 in the Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Colposcopy and cervical biopsy were performed for patients with abnormal Thin Prep® Papanicolaou test (TCT) results. Periodic colposcopy was performed every 8-12 weeks and cervical biopsy was performed if progression was suspected. Cervical cold knife conization was recommended to patients diagnosed with CINIII or microinvasive cervical carcinoma 6-12 weeks after delivery.
A total of 2,260 patients had abnormal TCT results (8.12 %). Colposcopy and cervical biopsy were performed for 369 patients. Fifteen patients had microinvasive squamous cell carcinoma, 116 patients had cervicitis, and the number of CIN patients with histological grades I, II, and III were 124, 49, and 65, respectively. Tumor progression during pregnancy was found in 253 patients (CINI or above). Prognosis varied depending on the highest grade of pathological diagnosis results during pregnancy or initial pathological diagnosis results performed 6-12 weeks after delivery by cervical biopsy under colposcopy. Treatment and follow-up were carried out according to diagnoses, state of progression, and reversion (if any).
These findings underline a need for cervical lesion screening for all women during pregnancy, and colposcopy should be performed for pregnant women who have abnormal TCT results. Appropriate treatment and follow-up were recommended according to different diagnosis of CIN.
评估妊娠及产后妇女宫颈上皮内瘤变（CIN）和宫颈微浸润性鳞状细胞癌的临床管理。
这项前瞻性研究纳入了2007年8月1日至2010年7月31日期间在北京首都医科大学附属北京妇产医院接受常规孕期检查的27230名孕妇。对薄层液基细胞学检测（TCT）结果异常的患者进行阴道镜检查和宫颈活检。每8 - 12周进行一次定期阴道镜检查，若怀疑病情进展则进行宫颈活检。对于诊断为CINIII或宫颈微浸润癌的患者，建议在产后6 - 12周进行宫颈冷刀锥切术。
共有2260例患者TCT结果异常（8.12%）。对369例患者进行了阴道镜检查和宫颈活检。15例为微浸润性鳞状细胞癌，116例为宫颈炎，组织学分级为I、II、III级的CIN患者分别为124例、49例和65例。在253例患者（CINI及以上）中发现孕期肿瘤进展。预后取决于孕期最高病理诊断结果或产后6 - 12周在阴道镜下宫颈活检的初始病理诊断结果。根据诊断、进展状态和逆转情况（如有）进行治疗和随访。
这些发现强调了孕期对所有妇女进行宫颈病变筛查的必要性，对于TCT结果异常的孕妇应进行阴道镜检查。建议根据CIN的不同诊断进行适当的治疗和随访。
