BACKGROUND:The 1991 Bethesda System for cervical/vaginal cytology reporting defined adequacy criteria for the unsatisfactory designation. Most laboratories have implemented these criteria, but clinical implications have not been established.

METHODS:Researchers at two university hospitals retrieved by computer search all unsatisfactory Papanicolaou (Pap) smears taken between January 1994 and July 1995. Of 71,872 total Pap smears, 208 (0.3%) were unsatisfactory (corresponding atypical rate of 9% and a dysplasia/carcinoma rate of 6.5%). Time interval to follow-up and clinicopathologic outcome were determined.

RESULTS:Approximately 26% of unsatisfactory Pap smears were from patients with a history of epithelial abnormalities. The majority (129 of 208 specimens; 62%) of follow-up Pap smears or biopsies occurred within 6 months, 5.7% within 6-12 months, and 1.4% in 12-18 months. Approximately 31% had no follow-up. The first repeat Pap smear or histologic specimen in 144 patients with follow-up was negative in 107 (74%), unsatisfactory in 6 (4%), atypical squamous cells of undetermined significance in 15 (10%), squamous intraepithelial lesion (SIL) in 13 (9%), and malignant in 3 (2%). Nonmalignant conditions contributing to the unsatisfactory smears on histologic specimens (12%) included cervicitis, endometritis, endometrial hyperplasia, and polyps. Progressive abnormalities after the first repeat specimen were noted in 7 patients (5%). A total of 23 of 144 initial unsatisfactory specimens (16% )were found to be from patients diagnosed with SIL or malignancy when all follow-up specimens were analyzed.

CONCLUSIONS:The majority of patients with unsatisfactory Pap smears had follow-up studies within 6 months. A significant number (16%) of those with follow-up had eventual diagnoses of SIL or neoplasia. Benign pathologic conditions also contributed to unsatisfactory smears. This patient subset was more likely to have a history of abnormalities, confirming the importance of peer/hierarchical review of unsatisfactory smears.

译文

背景:1991年用于宫颈/阴道细胞学报告的Bethesda系统定义了不合格名称的充分性标准。

方法:1994年1月至1994年1月间,两所大学医院的研究人员通过计算机搜索检索到的所有不满意的Papanicolaou(Pap)涂片均不令人满意和1995年7月。在71,872例子宫颈抹片检查中,有208例(0.3%)不满意(相应的非典型率为9%,异型/癌变率为6.5%)。确定随访时间和临床病理结果。

结果:约有26%的子宫颈抹片检查不满意是有上皮异常病史的患者。大部分随访检查(208个样本中的129个; 62%)在6个月内发生,在6-12个月内发生5.7%,在12-18个月内发生1.4%。大约31%的患者没有随访。 144例随访中首次进行重复巴氏涂片检查或组织学标本阴性(107%)(74%),不满意6例(4%),意义不明的非典型鳞状细胞15例(10%),鳞状上皮内病变(SIL) )在13(9%)中为恶性肿瘤,在3(2%)中为恶性肿瘤。导致组织学标本涂片不良的非恶性疾病(12%)包括宫颈炎,子宫内膜炎,子宫内膜增生和息肉。在第一个重复样本后发现有7例(5%)的进行性异常。在对所有随访标本进行分析后,总共发现144例最初不满意的标本中有23例(16%)来自被诊断为SIL或恶性肿瘤的患者。

结论:大多数子宫颈抹片检查不满意的患者中有6个月内进行了随访研究。接受随访的患者中,有很大一部分(16%)最终被诊断为SIL或瘤形成。良性病理状况也导致涂片不良。该患者亚组更可能具有异常病史,从而证实了对不满意涂片进行同行/分级检查的重要性。

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