-" Most HPV infection are transient. Only a minority group of HPV positive patients will eventually develop CIN lesions.”

感谢杨斌老师的课和这里不厌其烦的讨论加赐教，但我现在仍然有个疑问：以前我们那些报“黏膜慢性炎伴HPV感染”的现在应该如何报更合适？对于当次检查我们又如何能判定HPV感染到底是一过性的还是持续性的呢？盼回答，多谢！

1、HPV阳性？

退一万步说，即使是高危型HPV阳性，它也是不手术指征。

2、CIN1级累腺？

这种情况我在三级妇产科医院工作五年只见过一次。而且它也不是手术指征。

3、我为什么嘲笑我以前工作过医院的某些妇科医生为灭绝师太？

因为没有手术指征也敢手术，手术范围尽量大，有时还“买一送一”例如切子宫时顺便切除阑尾，“部分性葡萄胎”也要化疗而且因为患者是熟人就增加剂量并多做一次搞得白细胞下降为零而进入无菌病房“抢救”，本院职工的宫颈腺癌直到转移时才被诊断并且手术时忘了切除大网膜……

 夜深了，放松一下，开个玩笑提神，不要当真啊 

Thank you for your feedback and comments. These are great discussions among us. I totally understand your and lof of other pathologists' situation, particullary if you are working in so-called A or AA level hospital (not AAA三甲 hsopital). I understand lot of times it is not our pathologists' problem, but clinicians' chaotic. However, if we pathologists want to gain and maintain our respectful position, we pathologists, as a community, need to set up the bar or standard higher. A hospital without a high standard pathologic diagnosis will never be a good hospital, no matter how many good surgeons or medical doctors they have. So please do not feel discouraged with currrent chaotic situation in China, actually we are the part of the forces to change it and to transform the out of date medicine to modern medicine and to be able to connect with international medical or pathology community. That is what we are doing here. We should be proud of ourselves for our efforts. Thank you all for your participation in discussion here.

 谢谢杨老师的关注,怎么说呢,出现过治疗的结果原因是多方面的,国内的情况比较复杂：1、知识可能更新不足，喜欢跟风又对知识一知半解，往往根据自己主观臆断治疗；2、利益趋使，国内医生待遇相对较差，只能自已“多挣”，在我们医院就是先相对普查HPV，之后再选查TCT的，因为HPV是外送的，查一例300元；3、可能存在消极的自我保护，减少医疗风险，先用言语把病人吓个半死，然后宁可错杀一千，不肯放过一个。以上只是个人的一点看法，存在不是之处大家多多包涵。我们也常常会被临床医生气个半死，病人或家属来取报告时常常问我们结果如果，说好几天吃不下饭，睡不着觉了，临床医生告诉她很可能得宫颈癌了，就因为HPV检测结果有高危级的阳性，宫颈都没有见肿块，TCT也还没有做，和他们勾通就说病人是需要吓一吓的，不然万一存在了说我们没有给诊断出来。要想改变现状，估计是不可能一步到位的。

The clinical management in this case is totally ridiculous! That is why I emphasize that as a pathologist we should not just be a "morphologist", but also advocator in education and communicator with clinicians. Every year in our hospital, we pathologists will give lectures to clinicians and their residents/fellows. Lot of times we understand disease better because we bridge the pathology with molecular biology and clinical manegement.

Here are some facts that we all should know and should know how to answer clinicians and patients when questions are arising.

- Most HPV infection are transient. Only a minority group of HPV positive patients will eventually develop CIN lesions.

- Among HPV-positive women, about 15-25% of those will develop CIN-1 lesion, not all HPV-positive patients will have lesion

- Among women with ASC/LSIL or CIN1, up to 90% can regress spontaneously back to normal. Only <10% women with ASC?LSIL will progress to CIN2+ lesions

- Most women with CIN1 should be just followed with cervical cytology

- The main task for us (cytopathologists, pathologists and gynecological physicians) is to detect CIN2+ lesions as early as possible. Therefore, CIN1 is not really our focus, but just identify a high risk population who have higher chance than general population to progress to CIN2+ lesion.

As a pathologist, you should know all these facts and provide the scientific evidence to clinicians and patients. The 21st century is "evidence-based medicine" era.

If you still have quesions after reading this paragraph, please do not hesitate to ask more questions, I will be more than happy to discuss with you.

 No CIN.

HPV 阳性很多时候是一过性感染，不引起CIN.

“CIN Ⅰ级累腺？” 这几张一点征兆都没有，所以我们每张报告都是对本次活检而言。

另外我想请教各位老师：CINⅠ级或Ⅱ级累腺，算不算浸润癌？  临床曾经问过这样的问题，累腺就是突破基底膜了，那就是浸润啦，不是原位癌啦。怎么回答啊？ 病理报告可以“CINⅠ级或Ⅱ级累腺”这么打么？