2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors
2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors
复制标题
DOI：
10.1097/aog.0b013e3182883a34
复制
发表时间：
2013-04-01
影响因子：
7.2
通讯作者：
Lawson, Herschel W.
中科院分区：
文献类型：
--
作者：
Massad, L. Stewart;Einstein, Mark H.;Lawson, Herschel W.
2012年9月14日至15日，一个由代表23个专业协会、国家和国际卫生组织以及联邦机构的47名专家组成的小组在马里兰州贝塞斯达举行会议，修订2006年美国阴道镜和宫颈病理学共识指南。该组织的目标是为宫颈癌筛查异常、宫颈上皮内瘤变(CIN)和原位腺癌(AIS)的妇女提供修订的循证共识指南，此前采用了包含更长筛查间隔和联合检测的宫颈癌筛查指南。除了文献综述，来自北加州凯撒永久医疗保健计划的近140万女性的数据在异常测试后提供了风险证据。在有数据的情况下，指南为具有类似CIN 3、AIS和癌症风险的女性开出了类似的治疗方案。大多数先前的指导方针都得到了重申。更新的例子包括：人乳头瘤病毒阴性的未确定重要性的非典型鳞状细胞在恢复常规筛查前3年进行联合检测，不足以使65岁的妇女退出筛查；21-24岁的妇女需要较少的侵入性管理，特别是对于轻微的异常；阴道镜检查后的管理策略包括联合检测；报告为CIN 1的宫颈标本应被管理为CIN 1；在大多数情况下，即使联合检测的HPV结果是不满意的，也应重复细胞学检查，而大多数细胞学阴性且宫颈内细胞或转化区成分缺失或不足的病例无需深入跟进即可处理。(《妇科杂志》2013年版；第121期：829-46期)doi：http://10.1097/AOG.0b013e3182883a34
A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group's goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus-negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21-24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up. (Obstet Gynecol 2013;121:829-46) DOI: http://10.1097/AOG.0b013e3182883a34