【文献翻译】宫颈巴氏涂片缺乏转化区是否值得担忧?一条有关质量保证的建议

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       编者按:缺乏转化区(TZ)的宫颈样本,需不需要进行重复检查以降低宫颈异常风险呢?这篇文献翻译给出了确切的建议。   
【文献翻译】宫颈巴氏涂片缺乏转化区是否值得担忧?一条有关质量保证的建议
 
  01背 景
  Bethesda 指南并不要求宫颈巴氏涂片中存在转化区(TZ)。然而临床医师对报告中转化区样本的缺失十分在意。
  BACKGROUND: Bethesda guidelines do not require presence of transformation zone (TZ) for a cervical Pap test to be deemed adequate. However, clinicians are concerned with specimens that are reported to lack TZ.
  02方 法
  我们分析了566例巴氏涂片结果为未见上皮内病变或恶性病变(NILM)且在过去4年中(2007-2011)宫颈检查无异常的病例,将其分为有转化区信息组(ETZ)和无转化区信息组(NTZ)。研究者对这两个队列进行为期5年的随访,包括:年龄、HPV状态、取样时间(末次月经后大于14天)、后续管理、巴氏涂片检查间隔(<1、1-3、>3年)以及检查结果,并进行分组比较。
  METHODS: We analyzed 566 ThinPrep cases reported as negative for intraepithelial lesion or malignancy (NILM) with no cervical abnormality detected in previous 4 years (2007-2011). These cases were divided into two cohorts; those with TZ (ETZ) and those without TZ (NTZ). Patients' age, HPV status, time of sample collection (>14 days after last menstrual period), subsequent management, interval of subsequent Pap test (<1, 1-3, and >3 years), and result of subsequent examination were compared over a 5-year period.
  03结 果
  在5年的随访中,两组间巴氏涂片结果异常率无明显统计学差异(P<0.9520)。对于其他变量,研究者的数据也没有显示出统计学差异。对所有巴氏涂片异常的病例(93% ETZ and 7% NTZ)进行随访发现,ETZ组中随访的巴氏涂片检查结果显示,25%ASCUS仍报告为ASCUS,75%ASCUS报告为NILM;此外,75%LSIL报告为NILM,25%LSIL报告为ASCUS。一位报告为HSIL的患者接受了子宫切除,术后2年进行的2次巴氏涂片报告均为阴性。NTZ组中,1例ASCUS在随访中报告为NILM。
  RESULTS: The rate of abnormal Pap test on 5 year follow-up was not statistically significant (P<.9520) between cohorts. Our data demonstrates lack of statistical significance between the variables studied. Five year follow-up of all abnormal Pap smears were analyzed (93% ETZ and 7% NTZ). Of the ETZ group, 25% ASCUS remained as ASCUS and 75% were reported as NILM in subsequent Pap smears. Additionally, 75% of the LSIL were subsequently reported as NILM and 25% reported as ASCUS. One patient reported as HSIL underwent hysterectomy. Two Pap smears performed two years after surgery were negative. Within the NTZ group, one case of ASCUS was NILM upon follow-up.
  04结 论
  巴氏涂片为无转化区信息者在后续检查中并不具有更高的宫颈病变风险,不建议早期重复检查。对无转化区信息组病例进行重复筛查既不具有高性价比也不必要。
  CONCLUSION: Pap smears with NTZ were not at a higher risk for subsequent detection of cervical abnormalities, making earlier repeat testing unnecessary. Rescreening cases without TZ is neither cost effective nor necessary.
  参考文献:Polanco Jacome EC, Maerki J, Chau K, et al.Lack of transformation zone in cervical Pap tests, should it be a concern A quality assuranceinitiative. Diagn Cytopathol. 2018 Jul;46(7):584-588.

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