Powell Aime, Cohen Paul A, Spilsbury Katrina, Steel Nerida, Blomfield Penny
Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
Gynaecological Cancer Research Group, Bendat Family Comprehensive Cancer Centre, St John of God Hospital Subiaco, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2019 Apr;59(2):294-300. doi: 10.1111/ajo.12886. Epub 2018 Oct 4.
For Australian women with screen-detected adenocarcinoma-in-situ (AIS), an excisional biopsy is mandatory for further assessment, treatment, and to exclude the presence of cervical adenocarcinoma. The only exclusion to this rule is if the woman has a clinically evident invasive cervical malignancy. Excisional treatments should be tailored according to a patient's age and future obstetric needs. To date, practitioner compliance with this recommendation has not been investigated.
To investigate clinical management for patients with a cytological test result predicting AIS. Secondary aims were to report the most severe histological findings of excisional biopsy specimens following cytological prediction of AIS and investigate treatment outcomes for conservatively managed patients with biopsy-confirmed AIS.
A retrospective, population-based cohort study was conducted. Cases were ascertained from the Tasmanian and Western Australia Cervical Screening Registries. Cytology and histology results for women with an index cervical smear reporting AIS from 2001 to 2012 were reviewed.
Three hundred and twenty-one women (age range 18-69 years) had an index smear reporting AIS. Cervical cancer was diagnosed in 62 (19.3%) patients within the study cohort. Twenty-one of 321 patients (6.7%) were not initially managed according to the 2005 NHMRC Guidelines for the management of asymptomatic women with screen-detected abnormalities, including two women diagnosed with an occult cancer following a total hysterectomy.
A minority of women were not managed in accordance with guidelines. This is of concern given that nearly one in five women with a smear predicting AIS had a final diagnosis of cervical cancer.
对于澳大利亚经筛查发现原位腺癌（AIS）的女性，切除活检是进行进一步评估、治疗以及排除宫颈腺癌存在的必要手段。该规则的唯一例外情况是女性患有临床明显的浸润性宫颈恶性肿瘤。切除治疗应根据患者年龄和未来产科需求进行调整。迄今为止，尚未对从业者遵循该建议的情况进行调查。
研究细胞学检查结果预测为AIS的患者的临床管理情况。次要目的是报告在细胞学预测为AIS后切除活检标本的最严重组织学发现，并调查活检确诊为AIS的保守治疗患者的治疗结果。
进行了一项基于人群的回顾性队列研究。病例来自塔斯马尼亚州和西澳大利亚州的宫颈筛查登记处。对2001年至2012年索引宫颈涂片报告为AIS的女性的细胞学和组织学结果进行了审查。
321名女性（年龄范围18 - 69岁）的索引涂片报告为AIS。研究队列中有62名（19.3%）患者被诊断为宫颈癌。321名患者中有21名（6.7%）最初未按照2005年澳大利亚国家卫生与医学研究委员会（NHMRC）关于无症状女性筛查发现异常管理的指南进行管理，其中包括两名在全子宫切除术后被诊断为隐匿性癌症的女性。
少数女性未按照指南进行管理。鉴于涂片预测为AIS的女性中近五分之一最终被诊断为宫颈癌，这令人担忧。
