私人诊所中非典型和低级别宫颈细胞学检查的评估

Evaluation of atypical and low-grade cervical cytology in private practice.

作者信息

Nyirjesy I, Billingsley F S, Forman M R

机构信息

Cancer Prevention Studies Branch, Division of Clinical Sciences, National Cancer Institute, USA. stnyir@aol

出版信息

Obstet Gynecol. 1998 Oct;92(4 Pt 1):601-7. doi: 10.1016/s0029-7844(98)00274-9.

DOI:10.1016/s0029-7844(98)00274-9

PMID:9764636

Abstract

OBJECTIVE

To evaluate the adequacy of cytology alone for diagnosis of grade of cervical intraepithelial neoplasia (CIN) and to study performance of cytology, human papillomavirus (HPV) testing, and colposcopy in the evaluation of cytologic findings suggesting low-grade squamous intraepithelial lesions (SIL), or atypical squamous (ASCUS) or atypical glandular (AGCUS) cells of undetermined significance.

METHODS

Standard gynecologic and cytologic evaluation and colposcopic inspection as an additional screening approach were performed on women with no prior hysterectomies screened in a private practice between January 1, 1993, and August 1, 1995. Among these 7651 women, 367 had ASCUS, AGCUS, or SIL cytology or clinically or colposcopically visible cervical lesions. Sensitivity, specificity, and relative risk of CIN in the 367 women were compared by colposcopic, cytologic, histologic and virologic diagnoses.

RESULTS

The sensitivity of all non-negative Papanicolaou smears for CIN 2-3 and cancer was 92%, combined cytologic categories of high- and low-grade SIL were 59%, and high-grade SIL alone was 22%. Colposcopy was performed in all 367 patients, and positive findings led to biopsies in 48%. Colposcopy of patients with ASCUS increased detection of CIN 2-3 by 32% and CIN 1 by 48%. Cervical cytology was false negative in 8% of patients with CIN 2-3 and in 14% of those with CIN 1. These cases of CIN were detected by screening colposcopic inspection. High-risk HPV DNA was positive in 41% of women with CIN 2-3, and in 25% of those with CIN 1. The positive predictive value of ASCUS cytology increased from 5% to 42% for CIN 2-3 and from 30% to 85% for all grades of CIN in patients carrying high-risk HPV DNA. Virologic studies did not add to an increase in the sensitivity for CIN 2-3 among women in the low- and high-grade SIL cytology groups.

CONCLUSION

Because of the limited sensitivity of the high-grade SIL cytologic category for CIN 2-3, we recommend that all women with ASCUS, AGCUS, low- or high-grade SIL cytology be recalled for colposcopy, with biopsy only when indicated by colposcopic findings.

摘要

目的

评估单纯细胞学检查对诊断宫颈上皮内瘤变（CIN）分级的充分性，并研究细胞学、人乳头瘤病毒（HPV）检测及阴道镜检查在评估提示低级别鳞状上皮内病变（SIL）、意义不明确的非典型鳞状细胞（ASCUS）或非典型腺细胞（AGCUS）的细胞学检查结果中的表现。

方法

对1993年1月1日至1995年8月1日在一家私人诊所接受筛查且未行子宫切除术的女性进行标准的妇科和细胞学评估，并将阴道镜检查作为一种额外的筛查方法。在这7651名女性中，367名有ASCUS、AGCUS或SIL细胞学检查结果，或临床或阴道镜下可见的宫颈病变。通过阴道镜、细胞学、组织学和病毒学诊断比较这367名女性中CIN的敏感性、特异性和相对风险。

结果

所有巴氏涂片非阴性结果对CIN 2 - 3和癌症的敏感性为92%，高级别和低级别SIL联合细胞学分类为59%，单独高级别SIL为22%。所有367例患者均进行了阴道镜检查，其中48%的患者检查结果阳性并进行了活检。对ASCUS患者进行阴道镜检查使CIN 2 - 3的检出率提高了32%，CIN 1的检出率提高了48%。CIN 2 - 3患者中有8%、CIN 1患者中有14%的宫颈细胞学检查结果为假阴性。这些CIN病例通过筛查性阴道镜检查得以发现。高危型HPV DNA在CIN 2 - 3女性中41%呈阳性，在CIN 1女性中25%呈阳性。对于携带高危型HPV DNA的患者，ASCUS细胞学检查对CIN 2 - 3的阳性预测值从5%提高到42%，对所有级别CIN的阳性预测值从30%提高到85%。病毒学研究并未增加低级别和高级别SIL细胞学检查组女性中CIN 2 - 3的敏感性。