Mayeaux E J, Harper M B, Abreo F, Pope J B, Phillips G S
Department of Family Medicine, Louisiana State University Medical Center, Shreveport 71130.
J Fam Pract. 1995 Jan;40(1):57-62.
To determine the reliability of repeat cervical smears (Papanicolaou smears) in patients who have had an abnormal initial smear, prospective data were collected on patients being followed up for a previously abnormal cervical smear.
All 428 patients who were referred for colposcopy because of abnormal cervical smears underwent simultaneous cervical smears and coloposcopy with directed biopsy. Patients with colposcopic evidence of invasive carcinoma or a history of prior colposcopy were excluded. Cervical smear results were compared with the histologic findings on colposcopically directed biopsy. The ability of cervical smears to identify cervical intraepithelial neoplasia (CIN) and high-grade lesions (CIN 2 and 3) were also calculated for the repeat cervical smear.
The sensitivity of repeat Papanicolau screening for CIN was 48%. When differentiating high-grade lesions from low-grade and benign biopsies, the sensitivity of the repeat cervical smear was only 25%. Of 110 patients with biopsy-proven high-grade lesions, 68% had low-grade initial cervical smears and 73% had low-grade or benign repeat cervical smear cytology.
This study demonstrates that repeated Pap smears often fail to identify high-grade lesions and that the sensitivity of a repeat cervical smear is very low in patients with low-grade abnormalities found on routine screening examinations. Using follow-up cervical smears to monitor patients who have low-grade squamous intraepithelial lesions (LGSIL) carries unacceptable risks. A more reliable diagnostic test such as colposcopy is indicated.
为了确定初次宫颈涂片异常患者重复宫颈涂片（巴氏涂片）的可靠性，我们收集了因既往宫颈涂片异常而接受随访患者的前瞻性数据。
所有因宫颈涂片异常而转诊接受阴道镜检查的428例患者同时接受宫颈涂片和阴道镜引导下活检。排除有阴道镜检查提示浸润癌证据或既往有阴道镜检查史的患者。将宫颈涂片结果与阴道镜引导下活检的组织学结果进行比较。还计算了重复宫颈涂片识别宫颈上皮内瘤变（CIN）和高级别病变（CIN 2和3）的能力。
重复巴氏筛查CIN的敏感性为48%。在区分高级别病变与低级别和良性活检时，重复宫颈涂片的敏感性仅为25%。在110例经活检证实为高级别病变的患者中，68%的初次宫颈涂片为低级别，73%的重复宫颈涂片细胞学检查为低级别或良性。
本研究表明，重复巴氏涂片常常无法识别高级别病变，且在常规筛查检查中发现低级别异常的患者中，重复宫颈涂片的敏感性非常低。使用随访宫颈涂片监测低级别鳞状上皮内病变（LGSIL）患者存在不可接受的风险。需要采用更可靠的诊断检查，如阴道镜检查。
