Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
Gynecol Oncol. 2018 Jul;150(1):61-66. doi: 10.1016/j.ygyno.2018.05.019.
To evaluate the impact of pap tests on the time to diagnosis of cervical cancer.
In this population-based retrospective cohort study, Ontario women ≥21 years diagnosed with cervical cancer between 2011 and 2014 were identified and database data collected. The presence or absence of a pap test 0-2 years preceding cancer diagnosis was identified. Descriptive and modelling analyses were performed to determine the effect of pap results on cancer diagnosis.
2002 patients were identified, 75% received a pap test. 1250 patients had known cytology - 13% normal, 8% low-grade and 7.5% suspicious for cancer. Across all FIGO stages at diagnosis, 5-10% of cytology was low grade, 3-11.5% was positive for carcinoma and 4-41% was normal, which increased with advancing stage. For all cytology and FIGO stages (except stage 1A), OBGYNs had a significantly shorter time to diagnosis compared to family physicians. Factors increasing the odds of low-grade cytology were advanced stage (OR 4.5 (2.4-8.0), p < 0.01) and adenocarcinoma (OR 1.5 (1.1-2.1), p < 0.01). Low grade cytology resulted in the longest delay to diagnosis (p < 0.001).
Pap tests are performed frequently in the 0-2 years prior to the diagnosis of cervical cancer which can result in false negative cytology and diagnostic delay in patients with advanced cancers.
评估巴氏涂片检查对宫颈癌诊断时间的影响。
在这项基于人群的回顾性队列研究中，确定了 2011 年至 2014 年间在安大略省被诊断患有宫颈癌的年龄≥21 岁的女性，并收集了数据库数据。确定癌症诊断前 0-2 年内是否进行了巴氏涂片检查。进行描述性和建模分析以确定巴氏涂片结果对癌症诊断的影响。
共确定了 2002 名患者，其中 75%接受了巴氏涂片检查。1250 名患者有已知的细胞学检查结果-13%正常，8%低级别和 7.5%疑似癌症。在所有诊断时的 FIGO 分期中，5-10%的细胞学为低级别，8-11.5%为癌前病变阳性，4-41%为正常，随着分期的进展而增加。对于所有细胞学和 FIGO 分期（IA1 期除外），妇产科医生的诊断时间明显短于家庭医生。增加低级别细胞学的可能性的因素包括晚期（OR 4.5（2.4-8.0），p<0.01）和腺癌（OR 1.5（1.1-2.1），p<0.01）。低级别细胞学导致诊断延迟时间最长（p<0.001）。
在宫颈癌诊断前 0-2 年内经常进行巴氏涂片检查，这可能导致假阴性细胞学检查并导致晚期癌症患者的诊断延迟。
