Linder J, Zahniser D
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198-3135, USA.
Arch Pathol Lab Med. 1998 Feb;122(2):139-44.
The false-negative Papanicolaou (Pap) smear is the major quality issue currently facing the practitioners of diagnostic cytology. Failure to detect cervical disease in women can be due either to sampling error or to screening error. Sampling errors account for the majority of false-negative Pap tests; the remainder are due to the cervical abnormality either not being detected or not being properly classified during microscopic screening. The ThinPrep Pap test was recently cleared by the United States Food and Drug Administration as significantly more effective than the conventional Pap smear and as a replacement for the conventional method of Pap smear preparation. The ThinPrep Pap test increases detection of squamous intraepithelial lesions and significantly improves specimen quality. These features of the ThinPrep Pap test also have a heretofore unreported direct effect on the false-negative rate of the Pap examination. In two recently conducted clinical trials, the ThinPrep test resulted in a significant reduction in the sampling false-negative rate in women undergoing routine Pap screening. In addition, screening false negatives, as expressed by the false-negative proportion, were reduced from 5.6% with the conventional Pap smear, to 2.2% with the ThinPrep Pap test. More high-grade squamous intraepithelial lesions were detected in the screening populations with the ThinPrep test. The ThinPrep Pap test improves the quality of cervical cancer screening through a reduction in false-negative Pap examinations. This improvement has important implications for women undergoing Pap screening and for those who practice gynecologic cytopathology.
巴氏涂片假阴性是目前诊断细胞学从业者面临的主要质量问题。女性宫颈疾病未被检测出可能是由于取样误差或筛查误差。取样误差占巴氏涂片假阴性检测的大部分；其余则是由于在显微镜筛查期间宫颈异常未被检测出或未被正确分类。最近，美国食品药品监督管理局批准了薄层液基细胞学检测（ThinPrep Pap test），认为它比传统巴氏涂片显著更有效，可作为传统巴氏涂片制备方法的替代方法。薄层液基细胞学检测增加了鳞状上皮内病变的检测率，并显著提高了样本质量。薄层液基细胞学检测的这些特性对巴氏检查的假阴性率也有一个迄今未报道的直接影响。在最近进行的两项临床试验中，薄层液基细胞学检测使接受常规巴氏筛查的女性取样假阴性率显著降低。此外，以假阴性比例表示的筛查假阴性率从传统巴氏涂片的5.6%降至薄层液基细胞学检测的2.2%。在使用薄层液基细胞学检测的筛查人群中检测到了更多的高级别鳞状上皮内病变。薄层液基细胞学检测通过减少巴氏检查假阴性来提高宫颈癌筛查质量。这一改进对接受巴氏筛查的女性以及从事妇科细胞病理学的人员具有重要意义。
