护士从业者在健康维护组织中使用巴氏涂片加窥镜检查进行宫颈癌筛查。

Cervical cancer screening with papanicolaou smear plus speculoscopy by nurse practitioners in a health maintenance organization.

机构信息

Departments of Obstetrics and Gynecology *Kaiser Permanente Medical Office, La Palma †Kaiser Permanente Medical Center, Anaheim, CA.

出版信息

J Low Genit Tract Dis. 1997 Jul;1(3):141-7. doi: 10.1097/00128360-199707000-00005.

DOI:10.1097/00128360-199707000-00005

PMID:25951019

Abstract

OBJECTIVES

We set out to evaluate the utility of a magnified chemiluminescent screening examination (speculoscopy) as an adjunct to the Papanicolaou (Pap) smear in detection of cervical pathological processes by nurse practitioners and midwives in a health maintenance organization setting.

PATIENTS AND METHODS

Patients who presented for routine screening (N = 689) received a Pap smear and speculoscopy examination. If the Pap smear or speculoscopy result was positive, colposcopy was performed and biopsies were obtained from women with positive colposcopies. Data were analyzed using McNemar's adaptation of the chi-square test for correlated proportions.

RESULTS

In 80 patients from whom biopsies were obtained, Pap smear alone detected 67% of (6 of 9) and speculoscopy alone detected 77% of (7 of 9) high-grade squamous intraepithelial lesions (HGSILs). Pap smear alone detected 26% of low-grade squamous intraepithelial lesions (LGSILs) (10 of 38) whereas speculoscopy alone detected 84% (32 of 38) (p < .001). Combined use of Pap smear and speculoscopy showed a trend (p = .073) toward enhanced detection of HGSIL compared with either the Pap smear alone or speculoscopy alone.

CONCLUSIONS

Speculoscopy can be included in a nurse practitioner- and midwife-based cervical screening program, and the addition of this modality enhances the sensitivity of cervical screening by finding more high-grade and low-grade cervical disease than does pap smear alone.

摘要

目的

我们旨在评估放大化学发光筛选检查（窥镜检查）作为巴氏涂片的辅助手段，用于在健康维护组织环境中由护士从业者和助产士检测宫颈病理过程的效用。

方法

接受常规筛查的患者（N=689）接受巴氏涂片和窥镜检查。如果巴氏涂片或窥镜检查结果阳性，则进行阴道镜检查，并对阳性阴道镜检查的女性进行活检。使用麦克内马尔（McNemar）对相关比例的卡方检验的改编，对数据进行分析。

结果

在进行活检的 80 名患者中，单独的巴氏涂片检测出 67%（9 例中的 6 例）的高级别鳞状上皮内病变（HSIL），而单独的窥镜检查检测出 77%（9 例中的 7 例）的 HSIL。单独的巴氏涂片检测出 26%的低级别鳞状上皮内病变（LSIL）（38 例中的 10 例），而单独的窥镜检查检测出 84%（38 例中的 32 例）（p<.001）。巴氏涂片和窥镜检查联合使用与单独使用巴氏涂片或窥镜检查相比，显示出增强检测 HSIL 的趋势（p=0.073）。