Maggi R, Zannoni E, Giorda G, Biraghi P, Sideri M
First Department of Obstetrics and Gynecology, University of Milan, Italy.
Gynecol Oncol. 1989 Dec;35(3):294-6. doi: 10.1016/0090-8258(89)90066-8.
Repeat smear, colposcopy, and colposcopically directed biopsy were performed in 161 patients referred to our department because of a Pap smear showing mild dysplasia (CIN 1). Colposcopically directed biopsies revealed the presence of CIN of different grades in 61 cases (37.5%). In 33 (20.4%) the CIN grade found at biopsy was higher than 1. Repeat smear confirmed the presence of CIN 1 in 67 women (47.2%). In this group of patients colposcopically directed biopsies showed a CIN grade greater than 1 in 12 cases (17.9%). The repeat smear was negative in 59 patients (41.5%). In this group, biopsy showed varying grades of neoplasia in 12 cases. Colposcopic examination indicated no dysplasia but the presence of minor cervical abnormalities in 76 women (47.2%): at biopsy a CIN grade higher than 1 was found in 9 cases (11.5%). These data suggest that the mildly atypical smear identifies a group of patients at increased risk of CIN but gives little or no information on the disease severity. Repeat smear and colposcopic examination alone appear inadequate to demonstrate the severity of the cervical lesion. Due to the high proportion of CIN 2 and 3 in patients with a mildly abnormal smear, the systematic biopsy of any colposcopically abnormal area seems essential to proper management of the patient.
对因巴氏涂片显示轻度发育异常（CIN 1）而转诊至我科的161例患者进行了重复涂片、阴道镜检查及阴道镜引导下活检。阴道镜引导下活检显示61例（37.5%）存在不同级别的CIN。活检发现CIN级别高于1级的有33例（20.4%）。重复涂片证实67名女性（47.2%）存在CIN 1。在这组患者中，阴道镜引导下活检显示12例（17.9%）CIN级别大于1级。59例患者（41.5%）的重复涂片结果为阴性。在该组中，活检显示12例存在不同程度的肿瘤形成。阴道镜检查未发现发育异常，但76名女性（47.2%）存在轻微宫颈异常：活检发现9例（11.5%）CIN级别高于1级。这些数据表明，轻度非典型涂片可识别出一组CIN风险增加的患者，但关于疾病严重程度几乎没有提供任何信息。仅重复涂片和阴道镜检查似乎不足以显示宫颈病变的严重程度。由于轻度异常涂片患者中CIN 2和3的比例较高，对任何阴道镜检查异常区域进行系统性活检似乎对患者的正确管理至关重要。
