Rummel H H, Fick R, Heberling D, Schubert D
Geburtshilfe Frauenheilkd. 1977 Jun;37(6):521-6.
The cytological differential diagnosis "dysplasia" was made in 176 cases between January 1968 and June 1975. An immediate microscopic diagnosis was possible in 18 cases (10.22%). 14 cases eluded further follow-up. In 144 cases, long term observation was carried out. In some cases up to 6 years. Cytological regression to a permanently negative smear occurred in 57 patients (39.58%). A microscopic confirmation of the diagnosis was not obtained in these patients. In cytologically persistent cases microscopic confirmation was obtained after varying times of observation. The cytological differential diagnosis was correct in comparison to the histologic findings in 82.6% of the cases. 62 cases of the total (43.05%) showed cytological persistence of the suspicious smear. A cytological progression became apparent in 25 cases (17.36%) and was always subjected to microscopic confirmation by cone biopsy or primary hysterectomy. In 71 cases with microscopic confirmation persistent dysplasia was found in 64.78% of the cases and a progression occurred in 30.98% of the cases. 21.12% showed carcinoma in situ, 7.04% (5) cases showed a microinvasive carcinoma and 2 cases (2.82%) showed an invasive carcinoma. Cervical dysplasias are apparently capable of regression in a large number of cases. However about 10% of the cases will show progression to a micro-invasive or invasive carcinoma after varying lengths of time. In order to avoid unnecessary operations and to improve our knowledge on the biology of dysplasias, observation with cytological diagnosis dysplasia (Papanicolaou 3D) is justified.
1968年1月至1975年6月期间,共对176例患者做出了“发育异常”的细胞学鉴别诊断。其中18例(10.22%)可立即做出显微镜诊断。14例失访。144例进行了长期观察,部分观察时间长达6年。57例患者(39.58%)的涂片细胞学检查结果恢复为持续阴性,但未进行显微镜确诊。在细胞学检查结果持续异常的病例中,经过不同时间的观察后进行了显微镜确诊。与组织学检查结果相比,细胞学鉴别诊断的准确率为82.6%。62例(43.05%)患者的可疑涂片细胞学检查结果持续异常。25例(17.36%)出现细胞学进展,均通过锥形活检或根治性子宫切除术进行了显微镜确诊。在71例经显微镜确诊的病例中,64.78%为持续性发育异常,30.98%出现进展。21.12%为原位癌,7.04%(5例)为微浸润癌,2例(2.82%)为浸润癌。显然,大量宫颈发育异常病例能够自行消退。然而,约10%的病例在不同时间后会进展为微浸润癌或浸润癌。为避免不必要的手术并增进我们对发育异常生物学特性的了解,对诊断为发育异常(巴氏3级)的患者进行细胞学观察是合理的。