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一个病例引发的思考......

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楼主 发表于 2009-06-25 12:21|举报|关注(0)
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49岁。
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cqzhao 离线

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21 楼    发表于2009-06-25 18:47:00举报|引用
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本帖最后由 于 2009-06-26 03:59:00 编辑  

719

93

(12.9)

401

(55.8)

From my study you will notice that among 719 women with LSIL pap 12.9% had CIN 2/3 and 55.8% had CIN 1 in the histologic follow up. In other words, more than 30% women with lsil pap did not have cin lesion in the follow up biopsy.

Above is my study. Just sent to a journal to require for publication.

To the best of my knowledge it is the largest study on histologic follow up of LSIL pap with HPV testing.

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cqzhao 离线

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22 楼    发表于2009-06-25 18:42:00举报|引用
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Utility of HPV Triage for LSIL Cytology in Women 50 and Older: Efficacy Data From a Large Academic Womens Hospital Practice

 

                      Amer Heider, R. Marshall Austin, Chengquan Zhao*

 

 * Corresponding author

Magee-Womens Hospital of University of Pittsburgh Medical Center

Department of Pathology

300 Halket Street, Pittsburgh, PA 15213-3180, USA                                                    

 

 

 

 

ABSTRACT

   

Objective. Recent age-stratified evaluations have supported HPV triage of women with LSIL Paps at age thresholds ranging from over 35 to postmenopausal. We document correlation data on HPV testing and histopathologic follow-up from a large practice serving an older than average population.   

 

Methods. LSIL Pap tests with intermediate/high risk HPV DNA testing over a 34 month period between July 1, 2005 and April 30, 2008 were studied along with follow-up histopathological diagnoses. Patients were stratified into age groups, and tissue diagnoses were correlated with HPV test results.  

 

Results. 1,083 (80.2 %) of a total of 1,351 LSIL samples tested HPV positive. HPV prevalence declined in older age groups. 719 women with LSIL Pap and HPV test results had at least one follow-up cervical biopsy result. 89 of 612 patients with HPV positive LSIL (14.5%) had a follow-up histopathological diagnosis of CIN2/3. Only 4 of 107 patients with HPV negative LSIL (3.7%) had CIN 2/3. When stratified into ages <50 and ≥50, the sensitivity, specificity, PPV, and NPV of HPV testing with LSIL Pap results for CIN 2/3 detection were: sensitivity- 95.7% (<50) vs.100.0% (≥50), specificity- 14.9% (<50) vs. 26.1% (≥50), PPV- 15.0% (<50) vs.11.0% (≥50), and NPV- 95.2% (<50) vs.100.0% (≥50).

 

Conclusions. In the largest study to document histopathological follow-up of older women with LSIL and HPV test results, no histopathological CIN2/3 diagnoses were identified in patients 50 years and older with HPV negative LSIL. These findings support HPV triage testing for women 50 and older with LSIL results.

Table 3

Age Stratified (10 Year Intervals) Histopathological CIN Diagnoses                                         associated with HPV Positive and HPV Negative LSIL Pap Results                 

Age

Total

hrHPV Positive

hrHPV Negative

F/U No

CIN 2/3

(%)

CIN 1

(%)

F/U No

CIN 2/3

(%)

CIN 1

(%)

F/U No

CIN 2/3

(%)

CIN 1

(%)

10-19

44

6

(13.6)

29

(65.9)

40

6

(15.0)

26

(65.0)

4

0

(0.0)

3

(75.0)

20-29

234

24

(10.3)

141

(60.3)

211

23

(10.9)

128

(60.7)

23

1

(4.3)

13

(56.5)

30-39

189

31

(16.4)

94

(49.7)

164

30

(18.3)

84

(51.2)

25

1

(4.0)

10

(40.0)

40-49

156

24

(15.4)

82

52.6)

124

22*

(17.7)

75

(60.5)

32

2

(6.3)

7

(21.9)

50-59

67

3

(4.5)

40

(59.7)

48

3

(6.3)

31

(64.6)

19

0

(0.0)

9

(47.4)

≥60

29

5

(17.2)

15

(51.7)

25

5

(20.0)

13

(52.0)

4

0

(0.0)

2

(50.0)

Total

719

93

(12.9)

401

(55.8)

612

89

(14.5)

357

(58.3)

107

4

(3.7)

44

(41.1)

*1 case with CIN 3 and AIS

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cqzhao 离线

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23 楼    发表于2009-06-25 18:37:00举报|引用
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 Agree.

Pap is a screening test. pt with lsil pap can have negative biopsy.

Reasons: 1) not get the lesion by biopsy 2) small lesion regression 3) not a true LSIL in Pap test.

Pathologist is ok even you have over call Pap as LSIL. I think it is reasonable to call LSIL for above case.

The purpose of the biopsy for women with LSIL is to rule out high grade dysplasia or cancer.

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yaya 离线

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24 楼    发表于2009-06-25 18:20:00举报|引用
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 LSIL
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25 楼    发表于2009-06-25 17:15:00举报|引用
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  LSIL
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古茶 离线

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26 楼    发表于2009-06-25 12:31:00举报|引用
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 LSIL
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