Shlay J C, McGill W L, Masloboeva H A, Douglas J M
Department of Public Health, Denver Disease Control Service, Denver Health Medical Center, Colorado, USA.
Sex Transm Dis. 1998 Oct;25(9):468-75. doi: 10.1097/00007435-199810000-00005.
Pap smear screening studies in STD clinics have reported high rates of squamous intraepithelial lesions (SIL); however, there are limited data on levels of unsatisfactory smears of characteristics associated with cytologic abnormalities.
To assess the yield to Pap smear screening in an STD clinic and to evaluate the rates of and risk factors for atypia, low-grade SIL (LSIL), and high-grade SIL (HSIL).
A chart review of the clinic records of women undergoing Pap smear screening between 1991 and 1994 was conducted. Results were assessed from two different screening protocols, the first using a Dacron swab to obtain the endocervical sample and the second using a cytobrush.
Of 2034 Pap smears, 1313 (64.6%) were negative, 202 (9.9%) were unsatisfactory, 257 (12.6%) were atypical, 211 (10.4%) had LSIL, and 51 (2.5%) had HSIL. With the change to the cytobrush protocol, the rate of unsatisfactory smears decreased from 14.4% to 3% (p < 0.001), atypia increased from 10% to 16.7% (p < 0.001), and HSIL rose from 1.7% to 3.7% (p < 0.001). By multivariate analysis, atypia was associated with genital warts (odds ratio (OR) 1.53, 95% confidence interval (CI): 1.16-2.02); LSIL with younger age (p < 0.001, for trend), black race (OR 1.51, 95% CI: 1.08-2.10), genital warts (OR 1.81, 95% CI: 1.33-2.47), and an abnormal appearance of the cervix on examination (OR 2.49, 95% CI: 1.85-3.35); and HSIL with a previous abnormal Pap smear (OR 2.48, 95% CI: 1.08-2.10). Overall, abnormality rates were significantly higher in adolescents (35.5%) than older women (21.7%) (p < 0.01).
Obtaining satisfactory Pap smears among women undergoing screening in an STD clinic is feasible and cytologic abnormalities are common. These results continue to support the need for Pap smear screening in STD clinics, but the high rates in adolescents, a group in whom the natural history of cytologic abnormalities has not been well-defined, raise questions about the need to develop age-appropriate screening and management strategies.
性传播疾病（STD）诊所的巴氏涂片筛查研究报告显示，鳞状上皮内病变（SIL）的发生率很高；然而，关于不满意涂片水平以及与细胞学异常相关特征的数据有限。
评估STD诊所中巴氏涂片筛查的收益，并评估非典型性、低级别SIL（LSIL）和高级别SIL（HSIL）的发生率及危险因素。
对1991年至1994年间接受巴氏涂片筛查的女性的临床记录进行图表回顾。结果根据两种不同的筛查方案进行评估，第一种使用涤纶拭子获取宫颈管样本，第二种使用细胞刷。
在2,034例巴氏涂片中，1,313例（64.6%）为阴性，202例（9.9%）不满意，257例（12.6%）非典型，211例（10.4%）有LSIL，51例（2.5%）有HSIL。随着筛查方案改为使用细胞刷，不满意涂片的比例从14.4%降至3%（p<0.001），非典型性从10%增至16.7%（p<0.001），HSIL从1.7%升至3.7%（p<0.001）。多因素分析显示，非典型性与尖锐湿疣相关（优势比（OR）1.53，95%置信区间（CI）：1.16 - 2.02）；LSIL与年龄较小（趋势p<0.001）、黑人种族（OR 1.51，95%CI：1.08 - 2.10）、尖锐湿疣（OR 1.81，95%CI：1.33 - 2.47）以及检查时宫颈外观异常（OR 2.49，95%CI：1.85 - 3.35）相关；HSIL与既往巴氏涂片异常相关（OR 2.48，95%CI：1.08 - 2.10）。总体而言，青少年的异常率（占35.5%）显著高于老年女性（占21.7%）（p<0.01）。
在STD诊所接受筛查的女性中获取满意的巴氏涂片是可行的，细胞学异常很常见。这些结果继续支持在STD诊所进行巴氏涂片筛查的必要性，但青少年中的高发生率，这一群体细胞学异常的自然史尚未明确界定，引发了关于制定适合年龄的筛查和管理策略必要性的疑问。
