Krebs H B, Wheelock J B, Hurt W G
Obstet Gynecol. 1987 Apr;69(4):601-5.
We studied a total of 177 patients with cervical intraepithelial neoplasia or invasive carcinoma to evaluate the clinical implications of a positive endocervical curettage. All patients underwent cervical conization. One hundred and ten women had unsatisfactory colposcopy; 67 had satisfactory colposcopy. Patients with unsatisfactory colposcopy had a higher frequency of invasive lesions in the endocervix (9 versus 1.5%, P less than .05) and involvement of internal cone margins (12 versus 0%, P less than .01); they were also more likely to require additional, frequent treatment for persistent or recurrent disease (9 versus 1%, P less than .05) than patients with satisfactory colposcopy. Histologic review of the cone specimens in patients with satisfactory colposcopy revealed no lesion deeper in the endocervical canal than was predicted by colposcopic examination. These observations suggest that selected patients with positive endocervical curettage may be managed without diagnostic conization, if they had a satisfactory colposcopic examination.
我们共研究了177例宫颈上皮内瘤变或浸润癌患者，以评估宫颈管刮术阳性的临床意义。所有患者均接受了宫颈锥切术。110名女性的阴道镜检查结果不满意；67名女性的阴道镜检查结果满意。阴道镜检查结果不满意的患者宫颈管内浸润性病变的发生率更高（9%对1.5%，P<0.05），且内锥切缘受累的发生率更高（12%对0%，P<0.01）；与阴道镜检查结果满意的患者相比，她们也更有可能因持续性或复发性疾病而需要额外的频繁治疗（9%对1%，P<0.05）。对阴道镜检查结果满意的患者的锥切标本进行组织学检查发现，宫颈管内的病变深度并不比阴道镜检查预测的更深。这些观察结果表明，如果阴道镜检查结果满意，部分宫颈管刮术阳性的患者可能无需进行诊断性锥切术即可进行管理。
