Mannino J R
Department of Family Practice, Cleveland Clinic Florida, Ft Lauderdale 33309-1743, USA.
J Am Osteopath Assoc. 1998 Oct;98(10):542-6.
The regular Papanicolaou (Pap) smear is cornerstone of women's preventive healthcare. The introduction of the regular Pap smear as a screening tool for cervical cancer has markedly decreased the number of deaths from cervical cancer. During the past decade, however, the rate of death from cervical cancer has remained relatively static. This screening method is known to have a high rate of false-negative results; therefore, serial examinations are necessary for optimal sensitivity. The sensitivity of the routine pelvic examination is further increased with the addition of colposcopy to cytologic screening. Patients identified as having disease by colposcopy and biopsy but not by Pap smear (false-negative), are followed up, and the progression of their disease is documented until the Pap smear reflects the known change. A total of 276 patients whose Pap tests showed "no abnormal cells" and mild dysplasia (CIN-1 [cervical intraepithelial neoplasia]) by colposcopy and biopsy, who opted not to be treated, were followed up as a function of time. The results of the Pap test on the 276 patients progressed to a low-grade squamous intraepithelial lesion (LGSIL) or higher within 42 months. In this study, false-negative Pap tests that were identified by simultaneously performed colposcopy became positive within 42 months; therefore, careful repetitive screening is necessary. The author argues that a definitive, prospective study on the addition of colposcopy or similar adjunct procedure to the routine pelvic examination, in selected cases, is needed.
常规巴氏涂片检查是女性预防性医疗保健的基石。将常规巴氏涂片检查作为宫颈癌筛查工具的引入显著降低了宫颈癌的死亡人数。然而，在过去十年中，宫颈癌的死亡率一直相对稳定。已知这种筛查方法有较高的假阴性率；因此，为了获得最佳敏感性，需要进行系列检查。在细胞学筛查中增加阴道镜检查可进一步提高常规盆腔检查的敏感性。通过阴道镜检查和活检被诊断为患有疾病但巴氏涂片检查未发现异常（假阴性）的患者会接受随访，并记录其疾病进展情况，直到巴氏涂片检查反映出已知的变化。共有276例巴氏试验显示“无异常细胞”且经阴道镜检查和活检为轻度发育异常（CIN-1[宫颈上皮内瘤变]）的患者选择不接受治疗，并随时间进行随访。这276例患者的巴氏试验结果在42个月内进展为低级别鳞状上皮内病变（LGSIL）或更高级别病变。在本研究中，通过同时进行的阴道镜检查发现的假阴性巴氏试验在42个月内转为阳性；因此，需要进行仔细的重复筛查。作者认为，有必要针对在特定病例中将阴道镜检查或类似辅助程序添加到常规盆腔检查中开展一项确定性的前瞻性研究。
