子宫颈癌防治.pptVIP

子宮頸癌防治 下肢肿痛、接触性出血 Cervical Cancer Incidence of Cervical Cancer In Taiwan 子宮頸原位癌與侵襲癌之比例變遷（82年～88年） Based on a meta-analysis of 84 appropriately designed and conducted studies, conventional cytology has a specificity of 98% and a sensitivity of 51%. -- Agency of Healthcare Policy and Research, AHCPR Publication No. 99-E010, Feb. 1999 The Federal government under the Clinical Laboratory Improvement Act (CLIA) has required that 10% of smears be rescreened, but this has resulted in only limited reduction in the rate of false negative smears. --- JAMA, 1989;261:737 In 1997, an international Task Force on Cell Preparation Methods and Criteria for Sample Adequacy reported, Inadequate sampling and inappropriate sample transfer are the major causes of false negative results (~50%) ---Acta Cytologica 1996;42:25 Specimen Adequacy--- TBS 2001 (JAMA 2002; 287:2114-9) TBS 1988 1. Satisfactory 2. less than optimal ( satisfactory but limited by ---,1991) 3. Unsatisfactory At least 10 well-preserved endocervical cells or squamous metapalstic cells, clusters are no loger required ---transformation zone sampling Minimal squamous cellularity – 8,000 to 12,000 well-visualized squamous cells No more than 75% of epithelial cells obscured (usually by inflammation or blood) Cannot be accessioned by Lab. (e.g. unlabelled) Instrument Adjuvant Tests for Pap Smear Colposcopy Cervicography Automatic cytologic tests Fluid-based cytology HPV testing Fluorescence spectroscopy Colposcopy Colposcopy Limitations of colposcopy as a screening tool: 1. Low specificity with a high false-positive rate can result in overtreatment of a large number of patients 2. The invisibility of the squamocolumnar junction in some women leads to unsatisfactory evaluations 3.Experienced colposcopists are needed to perform adequate examinations, and there is significant interobserver variability It is better used as a diagnostic tool after abnormal Pap test Cervicography High quality colposcopic-type photo