Jackson S, Murdoch J, Howe K, Bedford C, Sanders T, Prentice A
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK.
Br J Obstet Gynaecol. 1997 Feb;104(2):140-4. doi: 10.1111/j.1471-0528.1997.tb11033.x.
Retrospective review of hospital case notes.
All hospitals in the South West Region of England.
Three hundred and twenty-four women with a diagnosis of cervical carcinoma: 191 were diagnosed in 1989 and 133 in 1993.
Documentation of patient assessment and management.
There was a mean delay of 17 days (range 0-66) from cervical smear to cytology report and 34 days (range 1-380) from general practitioner referral to attendance at a hospital clinic. Overall, 175 women (54%) had evidence of cytological assessment prior to treatment and 137 (42%) had a colposcopic assessment; 49% had cytological assessment and 37% had colposcopy in 1989, compared with 60% and 50%, respectively, in 1993. Excluding 49 cases of micro-invasive carcinoma, 238 case notes (86%) contained evidence of clinical examination; 195 women (71%) had had an examination under anaesthesia, 115 (42%) a chest radiograph, 123 (45%) an intravenous urogram or renal ultrasound, and 92 (33%) cystoscopy. One hundred and forty-seven women (53%) had FIGO staging recorded in the notes. As first line treatment, 69 had conservative surgery (39 for Stage IA), 138 had radiotherapy, and 107 had radical surgery. Ten had radical surgery for Stage IA but eight had a > 3 mm invasion or lymphatic/vascular spread. Thirty-one had Stage IB treated with radiotherapy of whom 14 were younger than 50 years of age. Following radical surgery 30% had evidence of sampling > or = 10 nodes, and 9% had tumour extending to the resection margins.
Record keeping was inadequate but appeared to indicate inconsistent cytological, clinical, colposcopic and radiological assessment, leading to inappropriate clinical delays and conservative surgery. Radical surgery often appeared inadequate, but poor node sampling rates may also reflect insufficient histopathological preparation or reporting. There was a reduction in the number of new cases of cervical carcinoma diagnosed in 1993, perhaps reflecting an observed increase in cytological surveillance. No other alterations in clinical practice were observed over the four-year period. We feel it is imperative to standardise assessment throughout the region with a minimum clinical and histopathological dataset.
对医院病历进行回顾性审查。
英格兰西南部地区的所有医院。
324例诊断为宫颈癌的女性：191例于1989年确诊，133例于1993年确诊。
患者评估和管理的记录。
从宫颈涂片到细胞学报告的平均延迟时间为17天（范围0 - 66天），从全科医生转诊到医院门诊就诊的平均延迟时间为34天（范围1 - 380天）。总体而言，175名女性（54%）在治疗前有细胞学评估的证据，137名（42%）有阴道镜评估；1989年，49%的患者有细胞学评估，37%有阴道镜检查，而1993年这两个比例分别为60%和50%。排除49例微浸润癌病例后，238份病历（86%）包含临床检查的证据；195名女性（71%）接受了麻醉下检查，115名（42%）进行了胸部X光检查，123名（45%）进行了静脉肾盂造影或肾脏超声检查，92名（33%）进行了膀胱镜检查。147名女性（53%）的病历中记录了国际妇产科联盟（FIGO）分期。作为一线治疗，69例接受了保守手术（39例为IA期），138例接受了放射治疗，107例接受了根治性手术。10例IA期患者接受了根治性手术，但其中8例存在>3mm的浸润或淋巴/血管扩散。31例IB期患者接受了放射治疗，其中14例年龄小于50岁。根治性手术后，30%的患者有证据表明取样≥10个淋巴结，但9%的患者肿瘤延伸至切除边缘。
记录保存不充分，但似乎表明细胞学、临床、阴道镜和放射学评估不一致，导致了不适当的临床延误和保守手术。根治性手术往往似乎不充分，但淋巴结取样率低也可能反映出组织病理学准备或报告不足。1993年诊断出的宫颈癌新病例数量有所减少，这可能反映了细胞学监测的增加。在这四年期间未观察到临床实践的其他变化。我们认为必须在整个地区规范评估，建立一个最低限度的临床和组织病理学数据集。
