절제수술로 치료한 자궁경부 상피내암과 미세침윤암에서 세포진과 조직진의 비교평가 = A Comparison of Cytologic Diagnosis to Histologic Diagnosis in the Patients with Carcinoma In Situ and Microinvasive Carcinoma Treated with Surgical Excisions

다국어 초록 (Multilingual Abstract)

We evaluated 221 patients who were preoperatively diognosed as carcinoma in situ(CIS) and microinvasive carcinoma(MIC) from Jan. 1988 to Dec. 1995 at the Department of Obstetrics and Gynecology, St. Mary`s hospital, Catholic University Medical College. The data gained from 221 patients with sucessful tollow-up were thoroughly reviewed to determine the proper diagnosis and treatment model. They were treated by conization, total abdominal hysterectomy or type II hysterectomy. The final diagnoses of 127 patients who got one cytologic diagnosis at local clinic or our hospital were 80 CIS, 45 MIC and 2 mvasive carcinomas. In cytology, 47 case(58.8 %) of 80 CIS showed abnormal findings as class III(30 %), IV(22.5 %) and V(6.3 %). In 45 MIC, 33(73.3 %) cases showed abnormal finding as class III(35.6 %), IV(28.9 %) and V(8.9 %). 94 patients who got cytology twice at the local clinic or our department were finally diagnosed as 72 CIS and 22 MIC. By repeating cytology, we could reduce false positive rate, 12.5 % in CIS and 4.5 % in MIC, however repeat cytology had little diagnostic value. In comparison of colposcopy guided biopsy(CGB) to non-colposcopic blind biopsy, CGB was more predictive. In CIS, the accurate diaganosis rates were 77.6 %(52/67) in blind biopsy and 88.8 %(95/124) in CGB. In MIC, the accuracies were 71.8%(28/39) in blind biopsy and 100 %(33/33) in CGB. So colposcopic evaluation with optional conization was essential for pooper diagnosis and treatment. There were unfavorable histologic findings: vaginal extension(n=4; 1.8 %), lymphovascular space involvement(n=4; 1.8 %), perineural invasion(n=1; 0.5 %) and occult invasive cancer(n=2; 1.8 %). So conservative treatment and local destructive therapy were potentially dangerous in CIS and MIC and should be performed after precise evaluation in selected cases. For proper diagnosis and treatment, cytologic evaluation had limited clinical values and CGB with optional conization was needed.