Fine B A, Feinstein G I, Sabella V
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-7836, USA.
Gynecol Oncol. 1998 Oct;71(1):46-9. doi: 10.1006/gyno.1998.5120.
The study was conducted to evaluate the pre- and postoperative value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia and invasive cervical cancer.
Patients undergoing cervical conization were studied retrospectively to evaluate the correlation of grade of preoperative endocervical curettage and the grade of dysplasia in the conization specimen. The role of routine preoperative ECC in satisfactory and unsatisfactory colposcopy and the need for routine ECC in the detection of postoperative residual dysplasia was also evaluated.
Results showed that 297/391 (76%) patients had ECC as part of preoperative assessment for cervical dysplasia on Papanicolaou smear. There was good association of grade of preoperative ECC and grade of conization specimen, weighted kappa-0.135 (P = 0.0003). Of 17 patients with invasive disease on conization specimen, only patients with a positive ECC had invasion at conization. None of 113 patients with a negative preoperative ECC had invasive disease on their conization specimens. The proportion of satisfactory colposcopic examinations between positive and negative ECC is not significantly different (P = 0.673). Follow-up of positive margins of resection was performed with Papanicolaou smear in only 20 patients and with Papanicolaou smear and ECC in 53 patients. In the latter group, 4% had a positive ECC with negative Papanicolaou smear (P = 0.310).
There is good agreement between grade of dysplasia on preoperative ECC and on subsequent conization specimen. Colposcopic examination was not a good predictor of pathology in the endocervical canal. Routine ECC should be part of the preoperative assessment of an abnormal Papanicolaou smear but may be unnecessary in the evaluation for residual dysplasia.
本研究旨在评估宫颈管刮术（ECC）在检测宫颈上皮内瘤变和浸润性宫颈癌方面的术前和术后价值。
对接受宫颈锥切术的患者进行回顾性研究，以评估术前宫颈管刮术的分级与锥切标本中发育异常分级之间的相关性。还评估了常规术前ECC在满意和不满意阴道镜检查中的作用，以及在检测术后残留发育异常方面常规ECC的必要性。
结果显示，297/391（76%）的患者将ECC作为巴氏涂片检查宫颈发育异常术前评估的一部分。术前ECC分级与锥切标本分级之间存在良好的相关性，加权kappa值为0.135（P = 0.0003）。在锥切标本中有浸润性疾病的17例患者中，只有ECC阳性的患者在锥切时有浸润。术前ECC阴性的113例患者中，其锥切标本均无浸润性疾病。ECC阳性和阴性患者之间满意的阴道镜检查比例无显著差异（P = 0.673）。仅对20例患者的切除切缘阳性进行了巴氏涂片随访，对53例患者进行了巴氏涂片和ECC随访。在后一组中，4%的患者ECC阳性而巴氏涂片阴性（P = 0.310）。
术前ECC的发育异常分级与随后锥切标本的分级之间有良好的一致性。阴道镜检查不是宫颈管病理的良好预测指标。常规ECC应作为巴氏涂片异常术前评估的一部分，但在评估残留发育异常时可能不必要。
