Department of Obstetrics and Gynaecology, Wansbeck Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
Department of Gynaecological Oncology, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK.
Br J Cancer. 2014 Aug 26;111(5):851-7. doi: 10.1038/bjc.2014.340. Epub 2014 Jun 26.
There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm.
This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis.
Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected.
Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.
英国针对宫颈管内细胞边界型核改变（BNC）的数据和指导有限。本研究旨在确定 BNC 患者的临床结局，评估阴道镜检查的准确性，并提出更稳健的管理算法。
这是 2006 年 1 月至 2011 年 12 月在诺森比亚医疗信托基金所有 BNC 转诊患者的回顾性研究。组织学诊断基于高级别组织学（CIN2 或更高级别）。在随访的第一年中发现的任何高级别组织学均包含在最终诊断中。
在 9001 例新转诊患者中，有 167 例患者为 BNC。初次评估时，37 例（22%）被诊断为高级别组织学。60 例患者阴道镜检查满意且阴性，其中 7 例（12%）在随访的第一年中发现高级别组织学/细胞学。总体而言，共发现 50 例高级别组织学（30%），包括 2 例浸润性癌。
目前对 BNC 的随访主要依赖阴道镜评估。在随访的第一年中，相当一部分阴道镜检查阴性的患者被发现存在高级别组织学。我们提出了一种更稳健的管理算法，以降低该亚组女性中漏诊高级别组织学的概率。
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