Burger R A, Monk B J, Van Nostrand K M, Greep N, Anton-Culver H, Manetta A
Department of Obstetrics and Gynecology, University of California, Irvine, USA.
Obstet Gynecol. 1995 Oct;86(4 Pt 1):491-8. doi: 10.1016/0029-7844(95)00204-5.
To evaluate the feasibility of a single-visit cervical neoplasia screening and intervention program.
A sample of asymptomatic, nonpregnant, indigent, adult women who had not had a Papanicolaou smear for at least 2 years (N = 126) was recruited through Spanish-language media in Orange County, California. Women who volunteered underwent a free, single-visit program combining a health questionnaire, education, an immediately read Papanicolaou smear, loop electrosurgical excision of the transformation zone for those with dysplastic cytology, and an exit questionnaire gauging satisfaction and educational impact. Main outcome measures included the frequency of cervical cancer risk factors and barriers to health care, incidence of cervical neoplasia, feasibility, short-term educational impact, and acceptability of interventions.
All 126 patients had at least one cervical cancer risk factor; 101 (80.2%) reported at least one barrier to health care. One hundred sixteen (92.1%) had a normal Papanicolaou smear, and three (2.4%) with a mildly atypical smear were referred for colposcopy. Seven (5.6%) patients had a dysplastic smear and underwent same-day loop electrosurgical excision of the transformation zone without complication, with histology revealing koilocytotic atypia (two patients), cervical intraepithelial neoplasia (CIN) I (two), CIN II (two), and CIN III (one). No case of invasive cervical carcinoma was identified. The mean time from performance of Papanicolaou smear to receipt of cytologic results was 2.2 hours, and the mean total visit time was 3.6 hours. Patients found the single-visit program to be both beneficial and satisfying.
This single-visit program is feasible and may overcome barriers to the diagnosis and management of cervical neoplasia in patients at high risk.
评估单次就诊的宫颈肿瘤筛查及干预项目的可行性。
通过加利福尼亚州奥兰治县的西班牙语媒体招募了126名无症状、非妊娠、贫困成年女性样本，她们至少两年未进行巴氏涂片检查。自愿参与的女性接受了一个免费的单次就诊项目，该项目包括一份健康问卷、健康教育、即时读取结果的巴氏涂片检查、对细胞学异常者进行转化区环形电切术，以及一份评估满意度和教育效果的出院问卷。主要结局指标包括宫颈癌危险因素的频率、医疗保健障碍、宫颈肿瘤的发病率、可行性、短期教育效果以及干预措施的可接受性。
所有126例患者至少有一项宫颈癌危险因素；101例（80.2%）报告至少有一项医疗保健障碍。116例（92.1%）巴氏涂片检查结果正常，3例（2.4%）轻度非典型涂片者被转诊进行阴道镜检查。7例（5.6%）患者涂片异常增生，当天接受了转化区环形电切术，无并发症，组织学检查显示挖空细胞异型性（2例患者）、宫颈上皮内瘤变（CIN）I级（2例）、CIN II级（2例）和CIN III级（1例）。未发现浸润性宫颈癌病例。从进行巴氏涂片检查到收到细胞学结果的平均时间为2.2小时，平均总就诊时间为3.6小时。患者认为单次就诊项目既有益又令人满意。
这个单次就诊项目是可行的，可能克服高危患者宫颈肿瘤诊断和管理的障碍。
