Massad L S, Lonky N M, Mutch D G, Mann W J, Blanco J S, Vasilev S A, Finan M A, Scotti R J
Department of Gynecologic Oncology, Washington University School of Medicine, Washington University Medical Center, St. Louis, Missouri.
J Reprod Med. 1993 Mar;38(3):163-9.
Since up to 45% of patients with atypical Papanicolaou smears have been shown to have significant pathology, women with persistent atypia are usually referred for colposcopy. This study evaluated the use of a new adjunctive screening test, speculoscopy, in selecting women with atypical Papanicolaou smears who would most benefit from referral for colposcopy. Both screening and referral patients were evaluated with the Papanicolaou smear, speculoscopy and colposcopy at 10 study centers. Biopsies were obtained from most women with positive colposcopy. The results in patients with atypical smears were used to perform a cost-benefit analysis of each of three management protocols. Using the results of speculoscopy to select women with atypical Papanicolaou smears for colposcopy provided a cost-effective alternative to performing colposcopy either on all women or on those with persistent atypia following treatment. Even when all women undergo speculoscopy at the time of screening, this protocol provides a cost savings of up to 24% and no significant loss of diagnostic accuracy. These data suggest that speculoscopy performed at the time of initial screening can accurately select women with atypical Papanicolaou smears who require colposcopy for diagnostic biopsy in a cost-effective manner.
由于高达45%的非典型巴氏涂片患者被证明存在严重病变，持续性非典型病变的女性通常会被转诊进行阴道镜检查。本研究评估了一种新的辅助筛查试验——直接观察镜检查，用于选择能从转诊阴道镜检查中获益最大的非典型巴氏涂片女性。在10个研究中心，对筛查和转诊患者均进行了巴氏涂片、直接观察镜检查和阴道镜检查。对大多数阴道镜检查阳性的女性进行了活检。非典型涂片患者的结果用于对三种管理方案中的每一种进行成本效益分析。利用直接观察镜检查的结果选择非典型巴氏涂片女性进行阴道镜检查，为对所有女性或治疗后持续性非典型病变女性进行阴道镜检查提供了一种具有成本效益的替代方案。即使所有女性在筛查时都接受直接观察镜检查，该方案也能节省高达24%的成本，且不会显著降低诊断准确性。这些数据表明，在初次筛查时进行直接观察镜检查可以以具有成本效益的方式准确选择需要进行阴道镜检查以进行诊断性活检的非典型巴氏涂片女性。
