Stastny J F, Remmers R E, London W B, Pedigo M A, Cahill L A, Ryan M, Frable W J
Department of Pathology, Virginia Commonwealth University, Health Science Division, Medical College of Virginia, Richmond 23298, USA.
Cancer. 1997 Dec 25;81(6):348-53. doi: 10.1002/(sici)1097-0142(19971225)81:6<348::aid-cncr9>3.0.co;2-h.
There is an increasing number of articles regarding the long term follow-up of Papanicolaou (Pap) smears with the diagnosis of atypical squamous cells of undetermined significance (ASCUS). Much controversy exists regarding the management of patients with this diagnosis. In a prior study in 1992, the authors performed automated rescreening of 101 ASCUS cases and 91 negative (control) cases. They found that through PAPNET-directed rescreening, 35 of 101 ASCUS cases (35%) could be reclassified as a squamous intraepithelial lesion (SIL).
These 192 women were followed since 1992 through manual look backs of subsequent Pap smears and surgical biopsies over a 4-year period. The population studied was comprised of predominantly black women between the ages of 14 and 85 years. The majority were considered a high risk population because many had a history of several sexual partners and multiple pregnancies.
Eighteen of 74 patients (24.3%) with an original diagnosis of ASCUS were found on subsequent Pap smears to have an SIL. Only 4 of 64 patients (6%) who originally had a negative Pap smear subsequently were found to have a low grade squamous intraepithelial lesion (LGSIL) within 4 years. Through ordinal logistic regression analysis, it was found that patients with an ASCUS diagnosis had a risk of developing SIL that was 2.6 times greater than the risk for patients with a negative smear diagnosis. Comparing the surgical biopsies in the control and ASCUS groups, there was no statistically significant difference in the risk of developing SIL. This may be because the number of follow-up biopsies were small.
A statistically significant difference of the risk of developing SIL exists between patients with a negative smear versus those with an ASCUS smear. Long term follow-up is essential in the management of the patients with an ASCUS smear because there is clearly an increased risk of developing SIL.
关于巴氏涂片诊断意义不明确的非典型鳞状细胞（ASCUS）的长期随访的文章越来越多。对于此类诊断患者的管理存在诸多争议。在1992年的一项先前研究中，作者对101例ASCUS病例和91例阴性（对照）病例进行了自动重新筛查。他们发现，通过PAPNET引导的重新筛查，101例ASCUS病例中有35例（35%）可重新分类为鳞状上皮内病变（SIL）。
自1992年起，对这192名女性进行了为期4年的随访，通过人工回顾后续的巴氏涂片和手术活检。研究人群主要为年龄在14至85岁之间的黑人女性。大多数人被视为高危人群，因为许多人有多个性伴侣和多次怀孕史。
最初诊断为ASCUS的74例患者中，有18例（24.3%）在后续巴氏涂片中被发现患有SIL。最初巴氏涂片为阴性的64例患者中，只有4例（6%）在4年内被发现患有低级别鳞状上皮内病变（LGSIL）。通过有序逻辑回归分析发现，诊断为ASCUS的患者发生SIL的风险比涂片阴性诊断的患者高2.6倍。比较对照组和ASCUS组的手术活检，发生SIL的风险没有统计学上的显著差异。这可能是因为随访活检的数量较少。
涂片阴性的患者与ASCUS涂片的患者发生SIL的风险存在统计学上的显著差异。对ASCUS涂片患者进行长期随访对于其管理至关重要，因为发生SIL的风险明显增加。
