Blain Gemma, Richards Anthony, Pather Selvan, Carter Jonathan, Saidi Sam
RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2016 Apr;56(2):207-11. doi: 10.1111/ajo.12450. Epub 2016 Feb 10.
The current Australian National Health and Medical Research Council guidelines discourage the use of 'see and treat' colposcopic management due to concerns regarding over-treatment. However, this approach has been shown to have benefits in several studies, including cost savings, elimination of loss to follow up and decreased patient anxiety.
To provide Australian data on treatment outcomes for women presenting with a high-grade Pap smear to a large metropolitan colposcopy unit and to determine whether a 'see and treat' approach would meet specified standards.
Retrospective review of women referred to the Royal Prince Alfred Hospital colposcopy unit with a high-grade smear. Patient data, colposcopy findings, treatment and pathology results were collated and analysed to determine treatment outcomes using the current 'biopsy and treat' approach. The feasibility of 'see and treat' was assessed by determining which women with high-grade colposcopy findings had high-grade disease confirmed on biopsy or excisional specimens.
One hundred and thirty-seven women underwent either excisional or ablative treatment. Of those undergoing excisional procedures, 81.3% had high-grade dysplasia or invasive cancer, 11.6% had CIN1 and 7.1% had no dysplasia on histopathology. One hundred and twenty-one with high-grade colposcopy findings had histopathology results available. Using a 'see and treat' approach, 92.6% would have had confirmed dysplasia of any grade, while 91.7% had confirmed high-grade dysplasia.
'See and treat' colposcopy is feasible in the Australian setting when applied to selected patients with high-grade cytology and high-grade colposcopic findings.
由于担心过度治疗，澳大利亚国家卫生与医学研究委员会现行指南不鼓励采用“即诊即治”的阴道镜管理方法。然而，多项研究表明这种方法具有诸多益处，包括节省成本、消除失访情况以及减轻患者焦虑。
提供澳大利亚一家大型都市阴道镜检查单位中，宫颈涂片高级别异常的女性患者的治疗结果数据，并确定“即诊即治”方法是否符合特定标准。
对转诊至皇家阿尔弗雷德王子医院阴道镜检查单位的宫颈涂片高级别异常的女性患者进行回顾性研究。整理并分析患者数据、阴道镜检查结果、治疗情况及病理结果，以使用当前的“活检并治疗”方法确定治疗结果。通过确定哪些阴道镜检查结果为高级别的女性在活检或切除标本上确诊为高级别疾病，评估“即诊即治”的可行性。
137名女性接受了切除或消融治疗。在接受切除手术的患者中，81.3%的组织病理学检查显示为高级别发育异常或浸润性癌，11.6%为CIN1，7.1%无发育异常。121名阴道镜检查结果为高级别的患者有组织病理学结果。采用“即诊即治”方法，92.6%的患者会被确诊为任何级别的发育异常，而91.7%的患者被确诊为高级别发育异常。
在澳大利亚的环境下，“即诊即治”阴道镜检查应用于选定的细胞学高级别且阴道镜检查结果为高级别的患者时是可行的。
