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
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DOI：
10.1097/lgt.0b013e318287d329
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发表时间：
2013-04-01
影响因子：
3.7
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，代表23个专业学会、国家和国际卫生组织以及联邦机构的47名专家在马里兰州贝塞斯达举行会议，修订2006年美国阴道镜检查和宫颈病理学会共识指南。该小组的目标是提供修订后的循证共识指南，用于管理宫颈癌筛查试验异常、宫颈上皮内瘤样病变（CIN）和原位腺癌（AIS）的妇女，该指南采用了宫颈癌筛查指南，其中包括更长的筛查间隔和联合检测。除了文献综述，来自凯撒永久北方加州医疗保健计划的近140万名妇女的数据提供了异常检测后风险的证据。在数据可用的情况下，指南为具有CIN 3，AIS和癌症相似风险的女性规定了类似的管理。大多数先前的指导方针得到重申。更新示例包括：人乳头状瘤病毒阴性的非典型鳞状细胞的未确定的意义的结果是随后的共同测试在3年前返回到常规筛查，并不足以退出妇女在65岁的筛选; 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纳入共同测试;报告为CIN 1的宫颈内取样应按CIN 1处理;在大多数情况下，不满意的细胞学检查应重复进行，即使联合检测的HPV结果已知，虽然大多数细胞学阴性的宫颈内细胞或转化区成分缺失或不足的病例可以在不进行强化治疗的情况下进行治疗，随访
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 papillonnavirus 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.