Hyun Ji Yeon, Min Kyung-Jin, Yang Sun Young, Lee Jae-Kwan, Hong Jin Hwa
Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Obstet Gynecol Sci. 2017 Jul;60(4):357-361. doi: 10.5468/ogs.2017.60.4.357. Epub 2017 Jul 14.
To determine whether triage for atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) from the updated American Society for Colposcopy and Cervical Pathology cervical cancer screening guidelines is applicable in Korean women.
We investigated women with ASC-US or LSIL including referred from local hospitals visited for cervical cancer screening at Korea University Guro Hospital from February 2004 to December 2014. Detailed information on the results of Papanicolaou (Pap) smears, human papillomavirus (HPV) DNA tests, and cervical biopsies were collected through chart review. Cervical biopsy results were compared in eligible women according to individual Pap smear findings and HPV DNA status.
Of 216,723 possible cases, 3,196 were included. There were 212 (6.6%) women with ASC-US and 500 (15.6%) with LSIL. The risk of ≥cervical intraepithelial neoplasia (CIN) 2 was significantly higher in women who were ASC-US/HPV+ than ASC-US/HPV- and LSIL/HPV+ than LSIL/HPV- (93.3% vs. 6.7% and 96.7% vs. 3.3%, <0.001 and <0.001, respectively). The risk of ≥CIN 3 was also significantly higher in women who were ASC-US/HPV+ than ASC-US/HPV- and LSIL/HPV+ than LSIL/HPV- (97.0% vs. 3.0% and 93.0% vs. 7.0%, <0.001 and <0.001, respectively). Age-stratified analysis revealed that more CIN 2 or CIN 3 was diagnosed in women aged 30 to 70 with ASC-US or LSIL when HPV DNA was present.
Observation with Pap and HPV DNA tests rather than immediate colposcopy is a reasonable strategy for ASC-US or LSIL when the HPV DNA test is negative, especially in women aged 30 to 70. Reflection of these results should be considered in future Korean screening guidelines.
确定美国阴道镜及宫颈病理学会（ASCCP）宫颈癌筛查指南更新版中对意义不明确的非典型鳞状细胞（ASC-US）和低度鳞状上皮内病变（LSIL）的分流方法是否适用于韩国女性。
我们调查了2004年2月至2014年12月在韩国大学古罗医院因宫颈癌筛查就诊的当地医院转诊来的ASC-US或LSIL女性患者。通过病历回顾收集巴氏涂片、人乳头瘤病毒（HPV）DNA检测结果及宫颈活检的详细信息。根据个体巴氏涂片结果和HPV DNA状态，对符合条件的女性患者的宫颈活检结果进行比较。
在216,723例可能病例中，纳入了3,196例。其中ASC-US女性患者212例（6.6%），LSIL女性患者500例（15.6%）。ASC-US/HPV阳性女性患者发生≥宫颈上皮内瘤变（CIN）2的风险显著高于ASC-US/HPV阴性女性患者，LSIL/HPV阳性女性患者高于LSIL/HPV阴性女性患者（分别为93.3%对6.7%和96.7%对3.3%，P均<0.001）。ASC-US/HPV阳性女性患者发生≥CIN 3的风险也显著高于ASC-US/HPV阴性女性患者，LSIL/HPV阳性女性患者高于LSIL/HPV阴性女性患者（分别为97.0%对3.0%和93.0%对7.0%，P均<0.001）。年龄分层分析显示，30至70岁的ASC-US或LSIL女性患者若存在HPV DNA，则诊断为CIN 2或CIN 3的比例更高。
当HPV DNA检测为阴性时，尤其是30至70岁的女性，采用巴氏涂片和HPV DNA检测进行观察而非立即行阴道镜检查是针对ASC-US或LSIL的合理策略。韩国未来的筛查指南应考虑反映这些结果。
