Should unsatisfactory colposcopy necessitate treatment of cervical intraepithelial neoplasia 1?
Should unsatisfactory colposcopy necessitate treatment of cervical intraepithelial neoplasia 1?
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阴道镜检查结果不理想是否需要治疗宫颈上皮内瘤变 1？
DOI：
10.1097/lgt.0b013e318057f330
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发表时间：
2008
影响因子：
3.7
通讯作者：
Boardman,LoriA
中科院分区：
文献类型：
--
作者：
Day,Tania;Weitzen,Sherry;Cooper,AmyS;Boardman,LoriA
目的：评估宫颈上皮内瘤变(CIN)2或更严重的患病率在接受宫颈上皮内瘤变(CIN)1锥形活检的妇女中，根据镜检查的充分性进行分层。材料和方法：采用镜数据库对1999年8月至2005年12月间的3,004名妇女进行横断面队列研究。收集的数据包括人口统计信息、治疗适应症、镜检查的充分性和最终的锥体病理。令人满意的阴道镜检查的定义是能够确定整个鳞状突交界处，并能完整地显示所有病变。结果：在440例锥体活检中，50例(11%)为CIN 1，其中9例(18%)为CIN 2或更差，23例(46%)为阴道镜检查不满意。与阴道镜检查满意的女性相比，阴道镜检查不满意的女性更有可能年龄更大(中位数年龄分别为33岁和25岁，p=。宫颈标本CIN-1(5/22[22%]vs0，p<；01)。持续(18个月或以上)CIN 1在阴道镜检查满意的妇女中更常见(21/27[78%]vs7/23[30%]，p<；01)。阴道镜检查不满意的妇女与检查满意的妇女相比，CIN2+的风险降低(1/23[4%]vs8/27[30%]，优势比=0.08，95%可信区间=0.01~0.95)。结论：阴道镜检查不满意和CIN1的妇女在最终病理上不太可能发生高级别的宫颈肿瘤。对于这一子组女性，保守治疗比立即治疗更可取。
Objective.To evaluate the prevalence of cervical intraepithelial neoplasia (CIN) 2 or worse among women undergoing cone biopsy for CIN 1, stratified by colposcopic adequacy.Materials and Methods.A cross-sectional cohort study was performed using a colposcopic database of 3,004 women seen between August 1999 and December 2005. Data collected included demographic information, indications for treatment, adequacy of colposcopic examination, and final cone pathology. A satisfactory colposcopy was defined as being able to define the entire squamocolumnar junction and visualize all lesions in their entirety. Descriptive statistics and crude and adjusted odds ratios with 95% confidence intervals were calculated.Results.Of the 440 cone biopsies, 50 (11%) were done for CIN 1, of which 9 (18%) demonstrated CIN 2 or worse, and 23 (46%) were done in the setting of unsatisfactory colposcopy. Compared with women with satisfactory colposcopy, women with unsatisfactory colposcopy were more likely to be older (median age= 33 vs 25 years, p=. 01) and to have CIN 1 on endocervical sampling (5/22 [22%] vs 0, p<. 01). Persistent (18 months or more) CIN 1 was more commonly encountered in women with satisfactory colposcopy (21/27 [78%] vs 7/23 [30%], p<. 01). Women with unsatisfactory colposcopic examinations were at decreased risk of CIN 2+ on final pathology compared with women with satisfactory examinations (1/23 [4%] vs 8/27 [30%], odds ratios= 0.08, 95% confidence intervals= 0.01-0.95).Conclusions.Women with unsatisfactory colposcopy and CIN 1 are unlikely to have high-grade cervical neoplasia on final pathology. For this subset of women, conservative management is preferable to immediate treatment.