자궁경부질세포진 검사에서 고식적 세포진 검사와 액상 세포진 검사 (PrepStain(TM) System)의 비교

이승아 ( Seung A Lee ),김정혜 ( Jung Hye Kim ),김조은 ( Jo Eun Kim ),박현주 ( Hyun Ju Park ),최원영 ( Weon Young Choi ),옥순애 ( Soon Ae Oak ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.11

목적 : 자궁경부 세포진 검사에 있어서 기존의 고식적 세포진 검사와 액상 세포진 검사와의 세포 진단 결과를 비교 분석하고, 그 차이를 알아보고자 하였다. 연구 방법: 2003년 8월 1일부터 2005년 7월 31일까지 본원 산부인과에 내원하여 세포진 검사를 시행받은 환자 중 고식적 세포진 검사를 시행받은 군 12,757명과 액상 세포진 검사를 시행받은 6,870명의 결과들을 비교하였으며, 이 중 질확대경하 생검을 통해 조직학적으로 확진된 고식적 세포진 검사를 시행받은 군 252명과 액상 세포진 검사를 시행받은 군 227명에 있어서 세포진 검사 결과와 조직학적 결과와의 일치도를 비교 분석하였다. 결과: 고식적 세포진 검사에 비해 액상 세포진 검사에서 ASCUS, LSIL, HSIL 그리고 CIS가 더 높은 빈도를 차지하였고, ASCUS/LSIL의 수치는 고식적 세포진 검사에서 3.32, 액상 세포진 검사에서 3.04를 나타내었다. 고식적 세포진 검사의 경우 민감도 71.8%, 특이도 93.9%, 양성 예측도 82.3%, 음성 예측도 89.4%, 위음성률 28.2%을 보였으며, 액상 세포진 검사는 민감도 72.6%, 특이도 96.1%, 양성 예측도 89.8%, 음성 예측도 88.0%, 위음성률 27.4%을 보였다. 결론: 액상 세포진 검사는 고식적 세포진 검사에 비해 세포진 검사의 양성 예측도를 향상시켜 세포진 검사의 정확도를 높일 수 있는 방법으로 자궁경부암의 선별 검사로써 진단율을 높이는 유용한 방법이라 할 수 있다. Objective: To Compare the conventional Pap smear with the Liquid Pap smear in screening of cervical cancer and to evaluate the correspondence of their biopsy results. Methods: From August 1, 2003 to July 31, 2005, the conventional Pap smears and the Liquid Pap smears were performed in 12,757 and 6,870 women, respectively. The results of 252 conventional Pap smear and 227 Liquid Pap smear were confirmed by colposcopic biopsy and evaluated for sensitivity, specificity, positive predictability, negative predictability and false negativity. Results: In Liquid Pap smear, there were higher proportions of ASCUS, LSIL, HSIL and CIS. And the ratio of ASCUS/LSIL were 3.32 and 3.04 in conventional Pap smear and Liquid Pap smear respectively. The conventional Pap smear showed sensitivity 71.8%, specificity 93.9%, positive predictability 82.3%, negative predictability 89.4%, and false negativity 28.2%, while the Liquid Pap smear showed higher sensitivity (72.6%), specificity (96.1%), and positive predictability (89.8%), and lower negative predictability (88.0%), and false negativity (27.4%). The positive predictability was significantly higher (95% C.I.: 1.3-13.7). Conclusion: The positive predictability was significantly improved in the Liquid Pap smear. Therefore, the Liquid Pap smear is a more useful method in screening of cervical cancer.

The Pap-Smear Test Experience of Women in Turkey: A Qualitative Study

Arabaci, Zeynep,Ozsoy, Suheyla Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.11

Objective: The study was planned with the purpose of examining the attitude of women who have pap-smear test for the early diagnosis of cervical cancer, factors affecting their decisions and their feelings and experiences during this period. Materials and Methods: A phenomenological method was used. Data were collected between March 2012 and April 2012 using standard and purposive samplings from 17 women. A detailed interview with women were held in their houses and recorded. The data collection tool consisted of two parts, one of which is information form with 17 questions identifying sociodemographic and cervical cancer risk factors of women and the second part is made up of semi-structured interview form with 15 alternative questions taking literature and the pap-smear test into consideration. Collected data were put into a written document. Content analysis was held by loading the documents into NVIVO 8 Statistical Programme. Results: The study comprised themes such as cervical risk factor, decision of taking pap-smear test, taking pap-smear test, knowledge about pap-smear test, relieving factors during pap-smear test, obstructive factors during pap-smear test, gynecological examination and feelings of women during and after pap-smear test while waiting for the results. Conclusions: As women perceive gynaecological examinations differently from other examinations, they have different feelings in each process of the Pap smear test. Medical staff should advise women more clearly on the nature and advantages of the Pap-smear test.

금연, 자궁암 검진 및 유방암 자가검진에 대한 인쇄매체를 이용한 보건교육의 효과

김인숙,김석범,강복수 韓國保健敎育學會 1998 보건교육건강증진학회지 Vol.15 No.2

To evaluate the impacts of the health education programs including smoking cessation, pap smear and breast self-examination(BSE), a community trial was conducted during one year from December 1996 to December 1997 in Kyongju City. Before health education, a base-line survey was implemented and the target population was allocated randomly to case and control groups. The case and control groups were divided into three categories which were smoking cessation, pap smear and BSE. The series of health education leaflets about anti-smoking, pap smear and BSE were mailed to case group and the evaluation survey was conducted at the end of this trial to compare the change of health related behaviours of case and control groups. Smoking prevalence of case group did not decline significantly after anti-smoking education but the cessation rates of the elderly and low educated were higher than others. The knowledge level of case group on the health risk associated with smoking was higher than that of control group and the willingness of case group to quit smoking was higher than the control group. The case group's compliance with pap smear for cervical cancer was more increased compared to control group after health education. Of the case group, the younger and lower educated women were screened at a higher rate than others. The knowledge level of case group on the risk factors of cervical cancer and how to prevent it was higher than that of control group. Nearly 60 percent of case group reported that the health education leaflet influenced them to have the pap smear. The unscreened cases were highly motivated to get the pap smear test in the future. The BSE practice rate of case group was highly increased after health education compared to control group. The knowledge level of case group on the risk factors of breast cancer and how to practice the BSE was higher than that of control group and the need and value of BSE were well recognized by case group. Nearly 80 percent of case group reported that the health education leaflet influenced them to do BSE. The cases who did not practice BSE were highly motivated to get the pap smear test in the future. In conclusion, the health education through mailing leaflets for BSE is more effective in encouraging the practice of BSE and get the pap shear test. This intervention did not increase smoking cessation rate significantly, and thus multi-displinary approach is required to reduce the smoking prevalence.

Is the Correlation between Papanicolaou Smear and Histopathology Results Affected by Time to Colposcopy?

Meevasana, Vorachart,Suwannarurk, Komsun,Chanthasenanont, Athita,Tanprasertkul, Chamnan,Bhamarapravatana, Kornkarn,Pattaraarchachai, Janya Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.4

Background: Time to colposcopy (TC) after abnormal Pap smears was evaluated for influence on cytohistologic correlation (CHC). Materials and Methods: This retrospective study assessed the correlation between TC and CHC of women who had abnormal Pap smears. Colposcopic chart review included participants from 2010-2013 who attended a colposcopic clinic, Thammasat University Hospital, Thailand. Results: Four hundred and sixty cases who had abnormal Pap smears were recruited. Pap reports were atypical smears with low grade squamous intraepithelial lesion (SIL), high grade SIL and cancer at 339, 114 and 7 cases, respectively. One hundred and twenty four patients underwent loop electrosurgical excision procedure (LEEP). A half of the cases were colposcopically examined within 1-2 months after abnormal Pap collection. CHC was 88 percent and not affected at all by TC. Subjects who attended cervical cancer screening from affiliated health providers had shorter TC than those screened in our tertiary hospital. Conclusions: Time to colposcopy with abnormal Pap smears conducted at Thammasat University Hospital had a highest frequency of 42 days, in line with the literature. Length of TC does not affect the correlation between Pap and histopathologic reports. A longer waiting period for colposcopy did not alter progression or regression of the disease.

울릉도 여성들의 자궁경부 세포학적 검사소견과 관련요인과의 관계

윤인숙,이혜자 THE KOREAN SOCIETY FOR BIOMEDICAL LABORATORY SCIEN 1998 Journal of biomedical laboratory sciences Vol.4 No.2

1998년 8월 5일부터 1998년 8월 12일까지 8일간 경상북도 울릉도에서 지역 여성 330명을 대상으로 자궁경부암 발생과 관련된다고 알려진 역학적 요인의 설문과 자궁경부암 집단검진으로 많이 이용되는 자궁경부 Pap. smear를 실시하여 다음과 같은 결과를 얻었다. 검사자의 평균연령은 52.1세였고 50대와 60대의 연령분포가 전체 검사자의 49.0%를 차지하였으며, 교육정도는 중학교 이하가 56.9%로 낮은 교육수준을 나타내었고, 첫 성교연령은 21세 이하가 43.9%를 차지하였고, 첫 임신 연령은 21세 이하에서 33.3%로 나타났다. 총 임신횟수는 5회 이상인 대상자는 전체의 52.1%를 차지하였고, 5회 이상의 출산을 한 응답자는 전체의 24.5%였다. 전체의 68.8%에서 유산경험이 있었으며, 대상자의 80.0%에서 남편이 포경수술을 하지 않은 것으로 나타났다. 증상은 전체의 52.1%에서 증상이 있다고 응답하였으며, 증상이 있는 응답자의 증상으로는 대하 48.3%, 소양증 21.5%로 나타났다. 자궁암세포검사 경험과 빈도에서 자궁암세포검사를 받아본적이 있는 응답자는 전체의 63.9%였으며, Pap. smear결과와 검사유무의 관찰에서 정상군보다 비전형세포와 이형성증이 있는 군에서 검사를 받아 본 경험이 유의하게 낮게 관찰되었다 (p<O.05). 검사를 받아 본 응답자 중 검사경험자의 44.1%에서 단 1회의 검사를 받아보았고, 30.3%는 비정기적으로 검사하였다. 한 번도 검사를 받은 경험이 없는 응답자의 이유로는 특별한 이상이 없었기 때문 51.3%, 부끄러움 때문에 16.8% 나타났다. 자궁경부도말의 세포학적 검사결과는 정상 45.8%, 염증47.3%, 트리코모나스증과 캔디다증이 1.8%, 비정형세포 4.5%, 이형성증이 0.6%였다. To study the incidence and epidemiological factors of uterine cervical cancer in medical underserved area females, the questionnaire survey and Pap. smear for uterine cervical cancer was done on total 330 women who lived in Ullungdo from 5th to 12th August, 1998. The results were summarized as follows: The age distribution of subjects was 50s (24.5%), 60s (24.5%) and their educational level was "no schooling" (14.2%) and "elementary school" (42.7%). The first coital age of subjects was 19∼21yrs (30.0%), 16∼18yrs (13.9%) and the first pregnancy age was 22∼24yrs (36.7%) and 19∼21yrs (30.0%). The frequency of total pregnancy of subjects was over 5 times (52.1%). The frequency of total delivery was "3∼4 times" (35.5%) and "5∼6 times" (15.2%). 68.8% of subjects had experience of abortion and 80.0% of their husband were on the phimosis. 172 (52.1%) subjects had gynecological symptoms, their symptoms were leukorrhea (48.3%), pruritus (21.5%) and leukorrhea with pruritus (20.3%). 63.9% of total subjects have been received Pap. smear and the frequency of their Pap. smear was "only 1 time" (44.1%), "irregularly" (30.3%) and the reason of respondents who have not been received Pap. smear was "no specific symptom" (51.3%). Among the 330 women screened there were negative (45.8%), inflammation (47.3%), trichomoniasis and candidiasis (1.8%), atypical cells (4.5%) and dysplasia (0.6%).

Incidental Finding of Abnormal Cervical Pathology in Hysterectomy Specimens after Normal Preoperative Papanicolaou Smears in Thammasat University Hospital

Chundarat, Pong-Anan,Suwannarurk, Komsun,Bhamarapravatana, Kornkarn,Pattaraarchachai, Junya,Thaweekul, Yuthadej,Mairaing, Karicha,Poomtavorn, Yenrudee Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.14

Background: To investigate abnormal cervical histopathology (ACH) from hysterectomy specimens with normal preoperative Papanicolaou (Pap) smears. Materials and Methods: Medical records from May 2009 to April 2012 were retrospectively reviewed of subjects from whom hysterectomy specimens were taken in Thammasat University Hospital. All had normal preoperative Pap smears. ACH was the primary outcome. A p-value less than 0.05 was considered significant. A total of 483 subjects with an average age of 50.5 years were recruited. Benign cases of enlarged uterus and pelvic mass were present in 94% (430/483). Endometrial and ovarian cancer were found at 6.2 and 4.7%, respectively. In hysterectomy specimens there were 19 (4%) cases of ACH. Silent ACH with benign disease, endometrial and ovarian cancers were 1.2% (5/430), 33.3% (10/30) and 17.4% (4/23), respectively. The negative predictive value (NPV) and false negative rate of Pap smears were 96 and 4%, respectively. ACH in malignant cases were 27.9% (12/43) and 20% (2/10) in adequate (APS) and inadequate (IPS) Pap collection groups, respectively. ACH in benign condition were 0.68% (2/292) and 2.2% (3/138) in APS and IPS, respectively. ACH was more often found in hysterectomy specimens with indication of malignancy than benign conditions with statistical significance. One third of preoperative stage I endometrial cancer cases had cervical involvement. Conclusions: Silent ACH in normal preoperative Pap smear was 4 %. Inadequate Pap smear collection is still the major problem in this study. Reducing inadequate Pap smear collection could reduce the false negative rate.

울릉도 여성들의 자궁경부 세포학적 검사소견과 관련요인과의 관계

윤인숙(In-sock Yoon),이혜자(Hye-Ja Lee) 대한의생명과학회 1998 Biomedical Science Letters Vol.4 No.2

1998년 8월 5일부터 1998년 8월 12일까지 8일간 경상북도 울릉도에서 지역 여성 330명을 대상으로 자궁경부암 발생과 관련된다고 알려진 역학적 요인의 설문과 자궁경부암 집단검진으로 많이 이용되는 자궁경부 Pap. smear를 실시하여 다음과 같은 결과를 얻었다. 검사자의 평균연령은 52.1세였고 50대와 60대의 연령분포가 전체 검사자의 49.0%를 차지하였으며, 교육정도는 중학교 이하가 56.9%로 낮은 교육수준을 나타내었고, 첫 성교연령은 21세 이하가 43.9%를 차지하였고, 첫 임신 연령은 21세 이하에서 33.3%로 나타났다. 총 임신횟수는 5회 이상인 대상자는 전체의 52.1%를 차지하였고, 5회 이상의 출산을 한 응답자는 전체의 24.5%였다. 전체의 68.8%에서 유산경험이 있었으며, 대상자의 80.0%에서 남편이 포경수술을 하지 않은 것으로 나타났다. 증상은 전체의 52.1%에서 증상이 있다고 응답하였으며, 증상이 있는 응답자의 증상으로는 대하 48.3%, 소양증 21.5%로 나타났다. 자궁암세포검사 경험과 빈도에서 자궁암세포검사를 받아본적이 있는 응답자는 전체의 63.9%였으며, Pap. smear결과와 검사유무의 관찰에서 정상군보다 비전형세포와 이형성증이 있는 군에서 검사를 받아 본 경험이 유의하게 낮게 관찰되었다 (p<0.05). 검사를 받아 본 응답자 중 검사경험자의 44.1%에서 단 1회의 검사를 받아보았고, 30.3%는 비정기적으로 검사하였다. 한 번도 검사를 받은 경험이 없는 응답자의 이유로는 특별한 이상이 없었기 때문 51.3%, 부끄러움 때문에 16.8% 나타났다. 자궁경부도말의 세포학적 검사결과는 정상 45.8%, 염증 47.3%, 트리코모나스증과 캔디다증이 1.8%, 비정형세포 4.5%, 이형성증이 0.6%였다. To study the incidence and epidemiological factors of uterine cervical cancer in medical underserved area females, the questionnaire survey and Pap. smear for uterine cervical cancer was done on total 330 women who lived in Ullungdo from 5th to 12th August, 1998. The results were summarized as follows: The age distribution of subjects was 50s (24.5%), 60s (24.5%) and their educational level was "no schooling" (14.2%) and "elementary school" (42.7%). The first coital age of subjects was 19~21yrs (30.0%), 16~18yrs (13.9%) and the first pregnancy age was 22~24yrs (36.7%) and 19~21yrs (30.0%). The frequency of total pregnancy of subjects was over 5 times (52.1%). The frequency of total delivery was "3~4 times" (35.5%) and "5~6 times" (15.2%). 68.8% of subjects had experience of abortion and 80.0% of their husband were on the phimosis. 172 (52.1%) subjects had gynecological symptoms, their symptoms were leukorrhea (48.3%), pruritus (21.5%) and leukorrhea with pruritus (20.3%). 63.9% of total subjects have been received Pap. smear and the frequency of their Pap. smear was "only 1 time" (44.1%), "irregularly" (30.3%) and the reason of respondents who have not been received Pap. smear was "no specific symptom" (51.3%). Among the 330 women screened there were negative (45.8%), inflammation (47.3%), trichomoniasis and candidiasis (1.8%), atypical cells (4.5%) and dysplasia (0.6%).

비디오 프로그램을 통한 정보제공이 중년여성의 자궁경부암 지식, 태도 및 조기검진 실천도에 미치는 효과

정귀임,박정숙 한국모자보건학회 2004 한국모자보건학회지 Vol.8 No.2

Objectives : The purpose of this study was to identify the effect of audiovisual information with videotape on knowledge, attitude and practice of Pap smear for early detection of cervical cancer. Methods : This study was planned as a non-equivalent control group pre-post test. The subjects were 72 women form 30 to 60 years old. They were divided 36 in experimental group and 36 in control group. The audiovisual information was a 25-minute documentary video program on basis of real situation. The measurement tools were the cervical cancerrelated knowledge and attitude questionnaires developed by the researcher, and practice of Pap smear. Results : 1) The experimental group which was offered the video program, was be higher in knowledge score of cervical cancer than the control group(t=18.293, p<0.001) and the experimental group which was offered the video program, was be higher in attitude score of cervical cancer than the control group(t=11.737, p<0.001). 2) The experimental group which was offered the video program, was be higher in practice of Pap smear than the control group(χ2=22.85, p<0.001). 3) The results of multiple logistic regression analysis showed that significant variables affecting practice of Pap smear were audiovisual information with videotape and the experience of practice of Pap smear for the past one year. Conclusions : This study showed that the audiovisual information with videotape was an effective nursing intervention to increase knowledge and attitude of cervical cancer and practice of Pap smear.

자궁경부암 진단을 위한 세포진검사의 분석

김기태,제구화,홍숙희,김현찬 인제대학교 1986 仁濟醫學 Vol.7 No.2

1980년부터 1985년까지 총 9.838례의 세포진 검사를 실시하였으며 그 중 Class I이 49.8%, Class II가 46.3%. Class III가 1.8%, Class IV가 7.4%, Class V가 1.7%이었고, 조직검사상 세포진검사보다 중증 (false negative)을 보인 경우가 8.8%, 세포진검사보다 경증(false positive)을 보인 경우가 2.8%, 중증, 경증 각각 한 등급 이내(one histological degree: central zone)에 속했던 경우가 88.4%이었다. A total number of 9,838 Pap's smears which were screened for the detection of uterine cervical cancer, during the period of 6 years from January 1980 to December 1985, Pusan Paik Hospital, Inje Medical College, were analyzed. And clinical and histopathological studies were made on the cases of Pap. class III or over. The results obtained are summarized as follows: 1.Among the 9,838 cases, there are 4,900 cases of class I (normal), 49.8%, 4,555 cases of class II (benign atypia), 46.3%; 177 cases of class III(dysplasia), 1.8%; 37 cases of class IV (carcinoma in situ), 0.4%; and 157 cases of class V (invasive carcinoma), 1.6%. 2.The age distribution of the total number of 9,838 Pap. smear shows the highest frequency at the age groups of 31-35, which accounts for 2,493 cases (25.3%), and 4th and 5th decades account for 45.4%. 3.Abnormal cytologic finding over class III were found in 383 cases (3.9%) and the average prevalence rate of over class III and class V were 3.9% and 1.6%. 4.As to the clinico-pathological analysis of the Pap. smear class III or over, the followings are summarized; a. Age distribution and prevalence rate; 1) By the age group, the highest frequency is in the age of 46-50 and 238 cases (62%) belongs to the age 41 or over. 2) In class V, the highest frequency is found at the age of 46-50 and 94 cases (60%) are in the age 46 or over. 3.) The prevalence rate shows increasing tendency by progress of the age and the peak rate is 15.9% at the age of 61 or over. Also in class V, the peak rate is 9.8% at the age of 61 or over. b. The average age by the degree of Pap. smear; The average age is 42.9 years in mild dysplasia, 43.3 years in moderate dysplasia, 42.7 years in carcinoma in situ, and 47.9 years in invasive carcinoma. c. The age of marriage and parity; 1) The age of marriage shows the highest frequency at the age of 19-21, and 66.6% married before the age of 21. 2) In class IV, 61% married before the age of 21 and the mean age is 20.9. In class V, the mean age is 19.4 and 77.8% married before the age of 21. 3) The parity shows the highest frequency at the number of 3-4 and the average number is 3.6. d. Clinical symptoms and gross findings of the cervix; 1) The clinical symptoms are vaginal bleeding, leukorrhea, and pelvic pain in the order of frequency and those of class IV, class V are same. 2) The most frequent finding is erosion and the normal cervix is found in 7%. 3) In class IV, the most frequent finding is erosion and the normal cervix is found in 8%. In class V, the most frequent finding is also erosion and the normal cervix is found in 1.9%. e. Histopathologic examination, performed in 220 (57.4%) among 383 cases of class III or over, shows 51 cases of dysplasia, 33 cases of carcinoma in situ, 28 cases of microinvasive carcinoma, and 86 cases of invasive carcinoma. In compared with the Pap's smear,88.4% of 220 cases is belonged to within one histologic degree (central zone), and the false negative and false positive cytologic examination were 8.8% and 2.8% respectively.

자궁경부 상피내종양의 선별검사로서 질확대경 검사의 임상적 의의

김수녕 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

The papanicolaou smear is the primary screening tool for cervical intraepithelial neoplasia (CIN) and invasive cervical cancer(ICC). False negative rates of Pap smear have been reported as high as 25-50%. Recent articles suggest that the use of colposcopy in addition to the Pap smear might improve the accuracy of CIN and ICC detection. However, colposcopic screening has not been practical because of its cost and the necessity of expertise in the evaluation of colposcopic findings. Because cervical cancer can be prevented by simple treatment of CIN, combined cytology and screening colposcopy is considered to be an important screening tool for CIN. The present study compared the usefulness of Pap smear with colposcopy in screening for CIN. Two hundred and forty-three gynecology patients were evaluated with cytology, colposcopy, and colposcopically directed biopsy. CIN and human papillomavirus infection were diagnosed by biopsy. We excluded patients with a history of an abnormal Pap smear within the past 12 months, or a history of abnormal vaginal bleeding. Fifteen patients (6.2%) had CIN lesions diagnosed by colposcopically directed biopsies. In 13 patients condylomatous lesions were found, in 7 patients CIN Ⅰ, in 3 CIN Ⅱ, and in 5 patients CIN Ⅲ were diagnosed. Sensitivity and specificity rates of Pap smear were 66.7% and 97.8%, respectively. The corresponding figures for coloposcopy were 80.0% and 98.2%. The combination of both methods led to optimal sensitivity and specificity(100%, respectively) Screening colposcopy is a valuable supplementary strategy for the detection of CIN, otherwise not detected with Pap smears.