Lieu D
Department of Pathology, University of California at Los Angeles, USA.
J Fam Pract. 1996 Apr;42(4):391-9.
Although the Papanicolaou (Pap) smear is one of the most effective screening tests ever invented for a common cancer, it remains an imperfect test. The technical shortcomings of the Pap smear have been compounded by the general public's unrealistically high expectations of the test's accuracy, underestimations of the importance of regular smears, and the actions within the medico-legal system. To remedy some of the technical shortcomings, the Bethesda System, which better reflects our current knowledge about cervical neoplasia, has been proposed to replace the old Papanicolaou classification system. Although standardized cytologic criteria may reduce interobserver variability, the false-negative rate of Pap smears is at least 5%, even in the best laboratories. No amount of training or experience with human observers can reduce the error rate to zero. Automated Pap screening holds the promise of higher sensitivity, but no instruments to date have been approved as a sole means of primary screening. The family physician can play a unique role in overcoming the limitations of the Pap smear by educating patients about the value and limitations of the test, instituting patient-specific treatment or follow-up of abnormal smears based on clinical and cytologic findings, and encouraging patients to get regular smears at intervals based on risk.
尽管巴氏涂片检查是有史以来为一种常见癌症发明的最有效的筛查测试之一，但它仍然是一种不完美的测试。巴氏涂片检查的技术缺陷因公众对该测试准确性的不切实际的高期望、对定期涂片重要性的低估以及医疗法律系统内的行为而更加严重。为了弥补一些技术缺陷，已经提出了更能反映我们目前对宫颈肿瘤认识的贝塞斯达系统，以取代旧的巴氏分类系统。尽管标准化的细胞学标准可能会减少观察者之间的差异，但巴氏涂片检查的假阴性率至少为5%，即使在最好的实验室也是如此。无论人类观察者接受多少培训或积累多少经验，都无法将错误率降至零。自动巴氏筛查有望提高敏感性，但迄今为止，还没有任何仪器被批准作为主要筛查的唯一手段。家庭医生可以通过向患者宣传该测试的价值和局限性、根据临床和细胞学检查结果对异常涂片进行针对患者的治疗或随访，以及鼓励患者根据风险定期进行涂片检查，在克服巴氏涂片检查的局限性方面发挥独特作用。
