Cervicography for triage of women with mi dly abnormal cervical cytology results
Cervicography for triage of women with mi dly abnormal cervical cytology results
复制标题
宫颈造影对宫颈细胞学结果轻度异常的女性进行分类
DOI：
10.1097/00006254-200202000-00015
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发表时间：
2002
影响因子：
6.2
通讯作者：
M. Litaker
中科院分区：
文献类型：
--
作者：
D. Ferris;M. Schiffman;M. Litaker
美国国家癌症研究所的多中心意义不明的非典型鳞状细胞（ASCUS）和低度鳞状上皮内病变（LSIL）分类研究（ALTS）开始确定最有效的治疗方案，为妇女与ASCUS或LSIL。作为这项工作的一部分，本研究调查的敏感性和特异性的宫颈造影在确定癌前病变的子宫颈。研究受试者是被转诊到四个参与临床中心之一的女性，用于评估巴氏涂片（Pap）上ASCUS或LSIL的诊断。患者被随机分配到三个治疗组之一：立即阴道镜检查、仅细胞学检查或人乳头瘤病毒（HPV）检测加细胞学检查。在患者就诊时常规进行宫颈造影术，作为“安全网”的一部分，旨在检测任何其他未识别的宫颈癌。出于本研究的目的，将入组检查的宫颈照片结果与立即阴道镜检查和HPV检测组中女性的细胞学和组织学结果进行比较。与2252例ASCUS和882例LSIL转介涂片进行了比较。宫颈造影结果在LSIL患者中更常见异常。在患有ASCUS的女性中，宫颈组织学显示11.6%（260/2252）的宫颈上皮内瘤变（CIN）≥ 2。在LSIL患者中，20.9%（184/882）发现CIN 2或以上。有444例最终诊断为CIN 2，222例最终诊断为CIN 3，将其与两个阳性检测阈值（非典型和LSIL）的宫颈造影结果进行比较。在非典型的临界值，宫颈造影检测CIN 3的敏感性为79.3%。为了达到这种敏感性，需要有41.8%的阴道镜检查率。在检测CIN 3的LSIL阈值时，宫颈造影的敏感性为65.8%，26.5%的妇女接受阴道镜检查。为了纠正当整个转化区不可见时宫颈造影术的有效性降低，对35岁以上和35岁以下患者的数据进行了重新分析。对于2527名年龄小于35岁的女性，宫颈造影术在非典型临界值检测CIN 3的敏感性为80.8%。这种敏感性水平需要47.3%的患者接受阴道镜检查。在607名35岁或以上的女性中，宫颈造影术检测CIN 3的敏感性为57.1%。在这个水平上，只有19.1%的妇女会被转诊接受阴道镜检查。
The National Cancer Institute's multicenter atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) triage study (ALTS) was begun to identify the most efficacious treatment protocols for women with ASCUS or LSIL. As a part of this effort, the present study investigated the sensitivity and specificity of cervicography in identifying premalignant lesions of the cervix. Study subjects were women who were referred to one of four participating clinical centers for evaluation of a diagnosis of ASCUS or LSIL on Papanicolaou (Pap) smear. Patients were randomly assigned to one of three treatment groups: immediate colposcopy, cytology only, or human papillomavirus (HPV) testing plus cytology. Cervicography was routinely performed at patient visits as a part of a "safety net" designed to detect any otherwise unidentified cervical cancer. For the purposes of this study, the cervigram results from the enrollment examination were compared with the cytological and histological results of the women in the immediate colposcopy and HPV testing groups. Comparison was made with 2252 ASCUS and 882 LSIL referral smears. Cervicography results were more frequently abnormal in the women with LSIL. Among women with ASCUS, cervical histology showed cervical intraepithelial neoplasia (CIN) 2 or greater in 11.6% (260 of 2252). Among those with LSIL, CIN 2 or greater was found in 20.9% (184 of 882). There were 444 final diagnoses of CIN 2 and 222 final diagnoses of CIN 3, which were compared with cervigram results at two positive test thresholds, atypical and LSIL. At the threshold of atypical, the sensitivity of cervicography would be 79.3% for detection of CIN 3. To achieve this sensitivity, it would be necessary to have a referral-to-colposcopy rate of 41.8%. At the threshold of LSIL for detection of CIN 3, the sensitivity of cervicography would be 65.8%, with 26.5% of the women referred to colposcopy. To correct for the decreased efficacy of cervicography when the entire transformation zone is not visible, the data were reanalyzed with the patients divided above and below 35 years of age. For the 2527 women younger than age 35, cervicography had a sensitivity of 80.8% for the detection of CIN 3 at the threshold of atypical. This level of sensitivity would require 47.3% of patients to be referred to colposcopy. In the 607 women 35 years old or older, cervicography had a 57.1% sensitivity for detection of CIN 3. At this level, only 19.1% of women would be referred for colposcopy.