Creasman W T, Clarke-Pearson D L, Ashe C, Weed J C
Cancer. 1981 Jul 15;48(2 Suppl):515-22. doi: 10.1002/1097-0142(19810715)48:1+<515::aid-cncr2820481313>3.0.co;2-b.
The patient with an abnormal Papanicolaou smear must have proper and adequate diagnostic evaluation to determine the degree of cervical abnormality. Gross clinical evaluation alone is inadequate for definitive diagnosis because cytologic screening identifies patients with preclinical disease. Outpatient diagnostic evaluation must include colposcopy, colposcopic-directed biopsies, endocervical curettage, and pelvic examination. Conization of the cervix is required whenever these techniques are unsatisfactory or are unable to rule out invasive cancer. When outpatient diagnostic procedures including cytologic analysis rule out invasive disease, one may elect cryosurgery, electrocautery, or laser in treating cervical intraepithelial neoplasia. Nevertheless, conization or hysterectomy may be inpatient treatments for selected patients.
巴氏涂片异常的患者必须进行适当且充分的诊断评估，以确定宫颈异常的程度。仅靠大体临床评估不足以做出明确诊断，因为细胞学筛查能识别出患有临床前疾病的患者。门诊诊断评估必须包括阴道镜检查、阴道镜引导下活检、宫颈管刮除术和盆腔检查。当这些技术不令人满意或无法排除浸润癌时，需要进行宫颈锥切术。当包括细胞学分析在内的门诊诊断程序排除浸润性疾病时，可选择冷冻手术、电灼或激光治疗宫颈上皮内瘤变。然而，对于部分患者，锥切术或子宫切除术可能需要住院治疗。
