Homesley H D, Jobson V W, Reish R L
J Reprod Med. 1984 May;29(5):311-6.
Colposcopically directed cervical biopsies performed by experienced colposcopists have greatly reduced the need for conization of the cervix to evaluate patients with cervical intraepithelial neoplasia (CIN). Because of the subjectivity of the colposcopic technique and variable time required to become skilled, continued reliance on cervical conization is often recommended to validate colposcopic findings for novice colposcopists . We assessed the colposcopic skill of residents in training in obstetrics and gynecology who had received 9-12 months of instruction in colposcopic techniques. Biopsies of each quadrant of the ectocervix were done after the resident recorded his or her colposcopic diagnosis. In 26% of the patients there was overestimation or underestimation of the histologic findings by more than one grade in the cervical quadrant suspected on colposcopy to contain the most advanced CIN lesion. In 30% of patients the histologically most advanced CIN lesion was not identified by the colposcopist . In 11% of patients with histologic findings of CIN both cytology and colposcopy were negative. Only 69% of the histologically confirmed lesions were diagnosed colposcopically by the resident colposcopists . The four-quadrant, colposcopically directed biospy technique is recommended as an effective training method for the beginning colposcopist .
由经验丰富的阴道镜医师进行的阴道镜引导下宫颈活检，极大地减少了为评估宫颈上皮内瘤变（CIN）患者而进行宫颈锥切术的必要性。由于阴道镜检查技术具有主观性，且熟练掌握所需时间因人而异，因此通常建议新手阴道镜医师继续依靠宫颈锥切术来验证阴道镜检查结果。我们评估了接受了9至12个月阴道镜技术培训的妇产科住院医师的阴道镜操作技能。在住院医师记录其阴道镜诊断后，对宫颈外口的每个象限进行活检。在26%的患者中，在阴道镜检查怀疑含有最严重CIN病变的宫颈象限中，组织学检查结果被高估或低估了一个以上级别。在30%的患者中，阴道镜医师未识别出组织学上最严重的CIN病变。在11%组织学检查结果为CIN的患者中，细胞学检查和阴道镜检查均为阴性。住院医师阴道镜医师仅通过阴道镜诊断出69%经组织学证实的病变。推荐采用四象限阴道镜引导活检技术作为初诊阴道镜医师的有效培训方法。
