宫颈瘤变的诊断与执行

摘要

直到20世纪80年代的最后一部分，子宫颈筛查都是狂热的，因此相当不一致。只是在最近的10年里，已经有了一个合理的计划，包括呼叫和审查以及GP目标。其影响是不言而喻的:人口的筛查范围从45%左右上升到35%以上，发病率和死亡率都发生了情绪变化。尽管子宫颈筛查项目的敏感性和特异性非常高，但考虑到所包含的数字显然是虚假的结果，确实会引起问题。敏感性的扩大不可避免地导致显性的下降，随之而来的是不安的扩大和潜在的无意义的治疗。

关键字

不利影响;药物;药理学。

关于的研究

人们常常忘记筛查的目的不是诊断和治疗宫颈上皮内瘤变，而是预防宫颈癌。我们无法区分筛查呈阳性且高风险的宫颈癌患者和筛查呈阳性但风险很小的宫颈癌患者，这是一个巨大的困难，也是非常昂贵的。因此，研究与该项目相关的其他模式非常重要，例如HPV亚型检测。然而，无论引入何种新制度，必须记住，它至少必须与我们现有的计划一样好。在某种程度上，该计划是自身成功的牺牲品。随着人口覆盖率的增加，大多数患有侵袭性宫颈癌的患者过去都曾进行过筛查，这代表了筛查过程的失败。这些人中很多在过去和现在都有正常的涂片。代表疾病的快速发展，但有些将代表过程中错误的影响。正是这些导致了诉讼和负面宣传。具有讽刺意味的是，许多这样的案例之所以被曝光，是因为英国所有实验室都在应用和评估商定的标准。 When standards are set, unless they are to be set at such a low level as to be almost meaningless, there will always be outliers who will need to address their problems in order to meet the standards. Despite having the best large population-based cervical screening programme in the world, the way in which the outliers in our system have been identified and their identification publicised has had the unfortunate effect of decreasing national confidence in the screening programme itself The publicity has driven cytoscreeners and cytopathologists into a more cautious approach, unbalancing the relationship between specificity and sensitivity with a consequent increase in overinvestigation, overtreatment, cost and morbidity. Whilst it is tempting to lay the blame for this at the door of a sensationalist media or the litigation lawyers, it is, arguably, more the effect of the misplaced zeal of colleagues acting as expert witnesses, demanding unrealistic and, probably, unachievable outcomes. The pathology service, and particularly the cervical screening programme, has been a standard bearer to the rest of the profession in the introduction of assessment, revalidation and clinical governance. It is to be hoped that the experience of the cytopathologists will be put to good use in avoiding a further series of public relations disasters.