Gompel C
Presse Med. 1998 Jun 6;27(20):971-3.
No screening test for cancer in asymptomatic patients can match the performance level of the Pap smear, yet no other screening test has been so strongly criticized in the popular press. For a large part, this paradoxical situation, greatly influenced by public opinion in the United States, has arisen from a utopic desire for a "perfect" screening system. Actually, though the Pap smear will never be 100% effective, it has made it possible to greatly reduce the prevalence of invasive cervical cancer. The fact that total eradication has not been achieved is not a sign of poor performance, but rather a signal for further improvement. Public education should be reinforced so the entire population, especially high risk groups of older women and those living in socially underprivileged conditions, can benefit from Pap smear screening programs. Clinicians and cytologists must also continue their efforts to assure quality smears and cytopathological examinations. In France, the Association for quality assurance in anatomy and pathological cytology, the Centers for collecting information on anatomy and pathological cytology, and the High Counsel for Public Health have taken innovative steps in this direction. The cytology report must also be written in a clear language, including a statement regarding the adequacy of the specimen, the description of the cells observed, a diagnosis and the use of an internationally accepted classification. Finally, patient follow-up is mandatory since the Pap smear technique is a screening method and cannot provide a definitive diagnosis. All positive smears must be confirmed by colposcopy and histologic assessment. Correctly used, the Pap smear remains the method of choice for the eradication of cervical cancer.
对于无症状患者，没有哪种癌症筛查测试能与巴氏涂片的性能水平相匹配，但也没有其他筛查测试在大众媒体上受到如此强烈的批评。在很大程度上，这种矛盾的情况在美国公众舆论的极大影响下，源于对“完美”筛查系统的乌托邦式渴望。实际上，尽管巴氏涂片永远不会100%有效，但它已使大幅降低浸润性宫颈癌的患病率成为可能。未能实现完全根除并非表现不佳的迹象，而是进一步改进的信号。应加强公众教育，以便全体民众，尤其是老年女性高危群体和生活在社会贫困条件下的人群，能够从巴氏涂片筛查计划中受益。临床医生和细胞学家也必须继续努力确保涂片质量和细胞病理学检查质量。在法国，解剖学和病理细胞学质量保证协会、解剖学和病理细胞学信息收集中心以及公共卫生高级顾问委员会已在这方面采取了创新举措。细胞学报告还必须用清晰的语言书写，包括关于标本充分性的说明、所观察细胞的描述、诊断以及使用国际认可的分类。最后，由于巴氏涂片技术是一种筛查方法，不能提供确定性诊断，因此患者随访是强制性的。所有阳性涂片必须通过阴道镜检查和组织学评估来确认。正确使用的话，巴氏涂片仍然是根除宫颈癌的首选方法。
