Spirtos N M, Schlaerth J B, d'Ablaing G, Morrow C P
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
Obstet Gynecol. 1987 Nov;70(5):729-33.
A prospective study was undertaken to critically evaluate the endocervical curettage. The study group consisted of 261 patients with colposcopically identifiable cervical lesions that had not been previously biopsied and were not macroscopically suspicious for invasive cancer. In 210 patients, the entire lesion, transformation zone, and squamocolumnar junction were visible (satisfactory colposcopy), and in 51 patients, the full extent of the lesion was not visualized colposcopically (unsatisfactory colposcopy). We used a method of examination not previously described. Colposcopy was performed before and after the endocervical curettage, but before the ectocervical biopsy. This method of examination allowed us to identify potentially contaminated endocervical curettages and to test the null hypothesis that a positive endocervical curettage in patients with satisfactory colposcopy is not the result of contamination. Twenty of 210 endocervical curettages in patients with satisfactory colposcopy were potentially contaminated, as suggested by an ectocervical lesion disrupted by the endocervical curettage. No patient with a positive endocervical curettage had an intact ectocervical lesion. Therefore, the null hypothesis was rejected (P less than .005). Of the 51 patients with unsatisfactory colposcopy, 39 (76%) underwent cone biopsy. Invasive cancer was diagnosed by cone biopsy in two patients when both ectocervical biopsy and endocervical curettage demonstrated only dysplasia. We also confirmed that patients with unsatisfactory colposcopy occasionally benefit from having an endocervical curettage. However, basing the treatment plan for any lesion short of invasive cancer solely on the results of colposcopy, ectocervical biopsy, and/or endocervical curettage could lead to significant undertreatment of some patients.
进行了一项前瞻性研究，以严格评估宫颈管刮术。研究组由261例患者组成，这些患者的宫颈病变在阴道镜下可识别，此前未进行过活检，且在肉眼下不怀疑为浸润癌。在210例患者中，整个病变、转化区和鳞柱交界可见（阴道镜检查满意），在51例患者中，病变的全部范围在阴道镜下未可视化（阴道镜检查不满意）。我们采用了一种以前未描述过的检查方法。在宫颈管刮术前后、宫颈外活检前进行阴道镜检查。这种检查方法使我们能够识别可能受污染的宫颈管刮出物，并检验这样一个零假设：阴道镜检查满意的患者宫颈管刮出物阳性不是污染的结果。阴道镜检查满意的患者中，210例宫颈管刮出物中有20例可能受污染，这是由宫颈管刮术破坏的宫颈外病变提示的。宫颈管刮出物阳性的患者没有完整的宫颈外病变。因此，零假设被拒绝（P小于0.005）。在51例阴道镜检查不满意的患者中，39例（76%）接受了锥形活检。当宫颈外活检和宫颈管刮术仅显示发育异常时，两名患者通过锥形活检诊断为浸润癌。我们还证实，阴道镜检查不满意的患者偶尔会从宫颈管刮术中受益。然而，仅根据阴道镜检查、宫颈外活检和/或宫颈管刮术的结果来制定任何非浸润癌病变的治疗方案可能会导致一些患者的治疗不足。
