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.
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.
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.
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.