Management of minor cervical cytological abnormalities: a systematic review and a meta-analysis of the literature
Φόρτωση...
Ημερομηνία
Συγγραφείς
Kyrgiou, M.
Koliopoulos, G.
Martin-Hirsch, P.
Kehoe, S.
Flannelly, G.
Mitrou, S.
Arbyn, M.
Prendiville, W.
Paraskevaidis, E.
Τίτλος Εφημερίδας
Περιοδικό ISSN
Τίτλος τόμου
Εκδότης
Περίληψη
Τύπος
Είδος δημοσίευσης σε συνέδριο
Είδος περιοδικού
peer-reviewed
Είδος εκπαιδευτικού υλικού
Όνομα συνεδρίου
Όνομα περιοδικού
Cancer Treat Rev
Όνομα βιβλίου
Σειρά βιβλίου
Έκδοση βιβλίου
Συμπληρωματικός/δευτερεύων τίτλος
Περιγραφή
BACKGROUND: A significant number of women are diagnosed with a low grade cytological abnormality on cervical screening. Many authorities recommend surveillance as spontaneous regression might occur. However, protracted attendance for cytological follow-up decreases with time and might put some women at risk of developing invasive disease. The aim of this review was to assess management options for women with minor cervical disease. METHODS: An electronic literature search was conducted. All randomised controlled studies comparing immediate colposcopy to cytological surveillance in women with cervical atypia/borderline nuclear changes or low-grade lesions were included. The main outcomes studied were the default rates from the colposcopy clinic and the histological status of biopsies within immediate management protocols compared to biopsies taken on completion of surveillance. Pooled relative risks and 95% confidence intervals were calculated using a random-effect model and inter-study heterogeneity was assessed with Cochrane's Q-test. RESULTS: Three randomised controlled trials identified from the literature search with different surveillance periods were combined. The analysis revealed that compliance with follow-up declines over time and reaches significance at the end of 24 months of surveillance (RR: 74.10 [10.36, 529.79]). There was a significantly higher incidence of HPV and CIN 1 in those women referred to immediate colposcopy/treatment compared to those at the end of 24 months surveillance period (32% vs 21%) (RR 1.49, 95% CI 1.17-1.90) and (21% vs 8%) (RR 2.58, 95% CI 1.69-3.94), respectively, possibly explained by spontaneous regression of clinically non-important lesions. Finally, there was no significant difference in the incidence of CIN2 or worse at initial colposcopy compared with the observation group (24 months) (RR 1.72, 95% CI 0.85-3.48). CONCLUSION: Cytological surveillance puts women at risk as many show poor compliance and such women might have occult high grade abnormalities. A general policy should be immediate colposcopy for all women after a single low grade cervical smear.
Περιγραφή
Λέξεις-κλειδιά
Cervical Intraepithelial Neoplasia/diagnosis/*prevention & control, Cervix Uteri/pathology, Colposcopy, Female, Humans, Papillomaviridae/genetics/*isolation & purification, Papillomavirus Infections/*diagnosis/virology, Precancerous Conditions/diagnosis, Randomized Controlled Trials as Topic, Risk Factors, Uterine Cervical Neoplasms/diagnosis/*prevention & control, *Vaginal Smears
Θεματική κατηγορία
Παραπομπή
Σύνδεσμος
http://www.ncbi.nlm.nih.gov/pubmed/17658693
http://ac.els-cdn.com/S0305737207000746/1-s2.0-S0305737207000746-main.pdf?_tid=203da9bdd2c5c1000b28829eb559babd&acdnat=1333714071_3768b92a7791397220fbc0a5f4e6c99b
http://ac.els-cdn.com/S0305737207000746/1-s2.0-S0305737207000746-main.pdf?_tid=203da9bdd2c5c1000b28829eb559babd&acdnat=1333714071_3768b92a7791397220fbc0a5f4e6c99b
Γλώσσα
en
Εκδίδον τμήμα/τομέας
Όνομα επιβλέποντος
Εξεταστική επιτροπή
Γενική Περιγραφή / Σχόλια
Ίδρυμα και Σχολή/Τμήμα του υποβάλλοντος
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής