Hariprasad Roopa, Mittal Srabani, Basu Partha
Department of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India.
Department of Preventive Oncology, Cancer Foundation of India, Principal investigator/BMGF Project, Child in Need Institute, Kolkata, India.
Cytojournal. 2022 Jun 14;19:40. doi: 10.25259/CMAS_03_15_2021. eCollection 2022.
Cytology identifies the women who are at higher risk of harboring high-grade cervical premalignant lesions or invasive cancer. However, a diagnostic test such as colposcopy is crucial for women with abnormal cytology for localization of the abnormality, confirmation of diagnosis, and appropriate management. To standardize this subjective technique and to minimize the interobserver variations, Swede scoring system was introduced. The revised colposcopic nomenclature of the International Federation of Cervical Pathology and Colposcopy in 2011 included various normal and abnormal colposcopic findings and gives a description of colposcopic features which improves its accuracy over the colposcopic indices. There is consensus agreement that cytology indicative of high-grade lesions (ASC-H and HSIL in the Bethesda system) should engender immediate referral for colposcopy and biopsy. The management of women who have equivocal or borderline cytology of low-grade abnormalities (ASCUS/LSIL) is still under deliberation. It is generally agreed to have an HPV triage for women with equivocal cytology. Based on the latest recommendations, the current chapter provides an extensive overview of the role of colposcopy in the management of women with various abnormalities reported on Pap smear.
细胞学检查可识别出患有高级别宫颈上皮内瘤变或浸润癌风险较高的女性。然而，对于细胞学检查异常的女性，诸如阴道镜检查这样的诊断性检查对于异常部位的定位、诊断的确认以及恰当的处理至关重要。为使这项主观性技术标准化并尽量减少观察者间的差异，引入了瑞典评分系统。2011年国际宫颈病理与阴道镜检查联合会修订的阴道镜命名法涵盖了各种正常和异常的阴道镜检查结果，并对阴道镜特征进行了描述，这提高了其相对于阴道镜指数的准确性。目前已达成共识，即提示高级别病变的细胞学检查结果（贝塞斯达系统中的ASC-H和HSIL）应立即转诊进行阴道镜检查和活检。对于低级别异常（ASCUS/LSIL）的意义不明确或临界性细胞学检查结果的女性的处理仍在商讨之中。对于意义不明确的细胞学检查结果的女性，普遍同意进行人乳头瘤病毒分流检测。基于最新建议，本章广泛概述了阴道镜检查在巴氏涂片报告有各种异常的女性处理中的作用。
