Jain A G, Higgins R V, Boyle M J
Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, USA.
Am J Obstet Gynecol. 1997 Aug;177(2):298-302. doi: 10.1016/s0002-9378(97)70190-x.
Our purpose was to determine whether prenatal colposcopy is beneficial in pregnant women with squamous atypia, atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesions on an initial screening Papanicolaou smear.
A retrospective chart review identified a cohort of pregnant patients referred to the colposcopy clinic at Carolinas Medical Center between October 1991 and December 1994 with squamous atypia, atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesions. Results of the colposcopic examination, cervical biopsy specimens, postpartum evaluation, and postpartum treatment were recorded. Descriptive statistics were used to tabulate numbers and percentages for all variables with 95% confidence intervals to determine disease progression.
Prenatal colposcopy was performed on 253 women during the study period. The colposcopic impression was normal or consistent with low-grade squamous intraepithelial lesions in 235 (93%) of the women. Of the 67 women who had a cervical biopsy, 6 had a histologic diagnosis of high-grade squamous intraepithelial lesions. Postpartum Papanicolaou smears were obtained in 224 patients; 71 (32%) were normal, 145 (65%) were unchanged, and 8 (3%) showed high-grade squamous intraepithelial lesions. Of the 69 patients who had a postpartum cervical biopsy, 4 were found to have high-grade squamous intraepithelial lesions. Eight of the 10 women with biopsy-proved high-grade squamous intraepithelial lesions were compliant with treatment after delivery. Histologic examination of the cervix with tissue obtained by either loop conization or cold knife conization showed no evidence of invasive carcinoma.
Squamous atypia, atypical squamous, cells of undetermined significance, or low-grade squamous intraepithelial lesions on a Papanicolaou smear in a pregnant patient does not require colposcopic evaluation during pregnancy. Progression of low-grade dysplasia to carcinoma during pregnancy is unusual, and no patient in this study was found to have invasive cancer.
我们的目的是确定产前阴道镜检查对初次筛查巴氏涂片显示为鳞状上皮细胞异型性、意义不明确的非典型鳞状细胞或低级别鳞状上皮内病变的孕妇是否有益。
一项回顾性病历审查确定了一组在1991年10月至1994年12月期间转诊至卡罗莱纳医疗中心阴道镜诊所的孕妇，她们患有鳞状上皮细胞异型性、意义不明确的非典型鳞状细胞或低级别鳞状上皮内病变。记录了阴道镜检查结果、宫颈活检标本、产后评估和产后治疗情况。使用描述性统计方法对所有变量的数量和百分比进行制表，并给出95%置信区间以确定疾病进展情况。
在研究期间，对253名女性进行了产前阴道镜检查。235名（93%）女性的阴道镜检查印象为正常或与低级别鳞状上皮内病变一致。在67名进行宫颈活检的女性中，6名组织学诊断为高级别鳞状上皮内病变。224名患者进行了产后巴氏涂片检查；71名（32%）结果正常，145名（65%）无变化，8名（3%）显示高级别鳞状上皮内病变。在69名进行产后宫颈活检的患者中，4名被发现患有高级别鳞状上皮内病变。10名经活检证实为高级别鳞状上皮内病变的女性中有8名在分娩后接受了治疗。对通过环形电切术或冷刀锥切术获取的宫颈组织进行组织学检查，未发现浸润癌迹象。
孕妇巴氏涂片显示鳞状上皮细胞异型性、意义不明确的非典型鳞状细胞或低级别鳞状上皮内病变，孕期无需进行阴道镜评估。孕期低级别发育异常进展为癌并不常见，本研究中未发现患者患有浸润癌。
