Jones M H, Jenkins D, Singer A
Mayday Hospital, Thornton Heath, London, UK.
Cytopathology. 1996 Feb;7(1):17-24. doi: 10.1046/j.1365-2303.1996.37582375.x.
Two years after introducing mandatory review of cases in which the cervical smear was discrepant with subsequent colposcopic or histological finding, the predictive accuracy of a first abnormal smear and the need for treatment were analysed. The results were compared with performance figures prior to this form of audit policy. Over 12 months 415 women referred for colposcopy were studied. Three per cent of patients with a single borderline smear and 6% with mild dyskaryosis had cervical intraepithelial neoplasia grade III (CINIII) revealed in histopathological examinations after colposcopy. Only 25% with a borderline smear and 33% with mild dyskaryosis required treatment. Of women with moderate dyskaryosis, 18% had a biopsy showing CINIII and 46% were treated. Of women with severe dyskaryosis in their cervical smear, 61% were shown to have CINIII or invasive cancer on biopsy and 90% were treated. Regular audit improved cytological prediction of grade of epithelial abnormality found on biopsy, allowing accurate, safe surveillance for minor smear abnormalities.
在引入对宫颈涂片结果与后续阴道镜检查或组织学检查结果不符的病例进行强制复查两年后，分析了首次异常涂片的预测准确性及治疗需求。将结果与这种审核政策实施前的表现数据进行了比较。在12个月期间，对415名转诊接受阴道镜检查的女性进行了研究。在阴道镜检查后的组织病理学检查中，3%的单次临界涂片患者和6%的轻度核异质患者被发现患有宫颈上皮内瘤变III级（CINIII）。只有25%的临界涂片患者和33%的轻度核异质患者需要治疗。中度核异质的女性中，18%的活检显示为CINIII，46%接受了治疗。宫颈涂片显示为重度核异质的女性中，61%的活检显示为CINIII或浸润癌，90%接受了治疗。定期审核改善了对活检中发现的上皮异常等级的细胞学预测，从而能够对轻微涂片异常进行准确、安全的监测。
