Mogensen S T, Bak M, Dueholm M, Frost L, Knoblauch N O, Praest J, Svanholm H
Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark.
Acta Obstet Gynecol Scand. 1997 Jan;76(1):69-73. doi: 10.3109/00016349709047788.
The validity of cytobrush and endocervical curettage combined with colposcopically directed biopsies in the diagnosis of cervical dysplasia and malignancy has not been evaluated in randomized trials. We aimed to elucidate the diagnostic validity of the two methods.
A prospective, randomized study of 180 consecutive patients. All patients were examined without anesthesia by colposcopically directed biopsies of the ectocervix and randomly assigned to either cytobrush or endocervical curettage. Patients with < or = CIN 1 were investigated with the alternative method three months later. Patients with > or = CIN 2 had a cone biopsy.
One hundred and thirty-one patients were evaluable. The sensitivity of cytobrush and endocervical curettage combined with colposcopically directed biopsies of the ectocervix was 96% and 84% (p = 0.08), respectively. The specificities of the two investigations were 95% and 88%, respectively (p = 0.78). All cytobrush specimens were evaluable but because of a low recovery of endocervical material a diagnosis could not be made in 12% of the patients examined by endocervical curettage.
The sensitivity of the combined use of cytobrush and biopsies of the ectocervix was equal to or higher than the sensitivity of endocervical curettage and ectocervical biopsies. The specificities of the two investigations were much alike. All cytobrush specimens were evaluable but a diagnosis could not be performed in 12% of the endocervical curettage specimens because of too little endocervical material. Furthermore, cytobrush is less inconvenient to the patient. Therefore, in the follow-up of patients with cervical dysplasia endocervical curettage may be replaced with cytobrush.
在随机试验中，尚未评估细胞刷和宫颈管刮术联合阴道镜引导下活检在诊断宫颈发育异常和恶性肿瘤方面的有效性。我们旨在阐明这两种方法的诊断有效性。
对180例连续患者进行前瞻性随机研究。所有患者在无麻醉情况下接受阴道镜引导下的宫颈外口活检，并随机分为细胞刷组或宫颈管刮术组。CIN 1及以下的患者在三个月后用另一种方法进行检查。CIN 2及以上的患者进行锥形活检。
131例患者可进行评估。细胞刷和宫颈管刮术联合阴道镜引导下的宫颈外口活检的敏感性分别为96%和84%（p = 0.08）。两项检查的特异性分别为95%和88%（p = 0.78）。所有细胞刷标本均可评估，但由于宫颈管材料回收率低，12%接受宫颈管刮术检查的患者无法做出诊断。
细胞刷与宫颈外口活检联合使用的敏感性等于或高于宫颈管刮术与宫颈外口活检的敏感性。两项检查的特异性非常相似。所有细胞刷标本均可评估，但12%的宫颈管刮术标本因宫颈管材料过少而无法进行诊断。此外，细胞刷对患者的不便程度较小。因此，在宫颈发育异常患者的随访中，宫颈管刮术可能会被细胞刷取代。
