Kupets Rachel, Lu Yan, Vicus Danielle, Paszat Lawrence
Division of Gynecologic Oncology, University of Toronto, Sunnybrook Regional Cancer Centre, Toronto ON.
Institute of Clinical Evaluative Sciences, Toronto ON.
J Obstet Gynaecol Can. 2014 Oct;36(10):892-899. doi: 10.1016/S1701-2163(15)30438-2.
When cervical cytology screening shows atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL), and cervical cytology screening has not been performed in the previous year, it is recommended that cytology screening be repeated six months later. Women with persistent abnormalities should be referred for colposcopy. We explored provincial databases in Ontario to determine whether these recommendations were always followed.
Cervical cytology reports in Ontario are contained in a provincial database, deterministically linkable to other health services databases, including those recording physician reimbursement claims for colposcopy. We identified all women in Ontario who had a first time diagnosis of ASCUS or LSIL in 2008 or 2009. We searched for additional cytology reports and for colposcopy billing claims during the 24 months following the date of the first abnormal report. We assessed the interaction of socioeconomic status, having abnormal cytology, and having repeat cytology after a report of low-grade abnormal cervical cytology.
A total of 74 770 women had a first time report of low-grade abnormal cytology. Among women with ASCUS and LSIL, 69.7% and 60.3%, respectively, underwent repeat cytology. Repeat cytology following ASCUS disclosed normal (68.2%), ASCUS (19.3%), LSIL (10.6%), and high-grade squamous intraepithelial lesion (1.4%); following LSIL, the corresponding percentages were 48.3%, 18.0%, 30.8%, and 2.6%. Of women with ASCUS, 16.2% went directly for colposcopy; 14.0% did not repeat cytology or go for colposcopy. Of women with LSIL, 26.4% went directly for colposcopy but 13.4% had no follow-up.
We have demonstrated the potential for substantial improvement in cervical cytology six months after a finding of ASCUS and LSIL. We found that many women with ASCUS and LSIL had unnecessary referrals directly for colposcopy, and we identified a lack of follow-up for one sixth of women with low-grade abnormal cytology.
当宫颈细胞学筛查显示意义不明确的非典型鳞状细胞（ASCUS）或低度鳞状上皮内病变（LSIL），且上一年未进行宫颈细胞学筛查时，建议在六个月后重复进行细胞学筛查。持续存在异常的女性应转诊进行阴道镜检查。我们查阅了安大略省的省级数据库，以确定这些建议是否始终得到遵循。
安大略省的宫颈细胞学报告包含在一个省级数据库中，可确定性地与其他医疗服务数据库相链接，包括记录阴道镜检查医生报销申请的数据库。我们确定了安大略省所有在2008年或2009年首次诊断为ASCUS或LSIL的女性。我们在首次异常报告日期后的24个月内搜索了额外的细胞学报告和阴道镜检查计费申请。我们评估了社会经济地位、细胞学异常以及在低度宫颈细胞学异常报告后进行重复细胞学检查之间的相互作用。
共有74770名女性首次报告低度细胞学异常。在患有ASCUS和LSIL的女性中，分别有69.7%和60.3%进行了重复细胞学检查。ASCUS后重复细胞学检查结果显示正常（68.2%）、ASCUS（19.3%）、LSIL（10.6%）和高度鳞状上皮内病变（1.4%）；LSIL后相应的百分比分别为48.3%、18.0%、30.8%和2.6%。患有ASCUS的女性中，16.2%直接进行了阴道镜检查；14.0%未重复进行细胞学检查或未进行阴道镜检查。患有LSIL的女性中，26.4%直接进行了阴道镜检查，但13.4%没有后续跟进。
我们已经证明，在发现ASCUS和LSIL六个月后，宫颈细胞学检查有大幅改善的潜力。我们发现，许多患有ASCUS和LSIL的女性直接进行不必要的阴道镜转诊，并且我们发现六分之一的低度细胞学异常女性缺乏后续跟进。
