MonoPrep을 이용한 자궁경부 세포진 검사의 유용성:고식적 세포진 검사와의 비교 연구
Comparison of Efficacy between MonoPrep and Papanicolaou Smearfor Cervical Cancer Screening
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적 : 자궁경부 세포진 검사에 있어서 고식적인 방법과 액상 세포진 검사 방법의 하나인 MonoPrepⓇ을 이용한 방법간의 검체의 적정성과 세포진단 결과를 비교하여 MonoPrepⓇ법의 유용성에 대하여 알아보고자 하였다. 연구 방법 : 2002년 9월부터 2003년 2월까지 아주대학교병원 산부인과 외래에서 자궁경부 조직검사를 시행받은 환자들 중 임의로 선택한 156명을 대상으로 고식적인 방법과 MonoPrepⓇ법을 이용한 세포진 검사를 시행하여 두 검사 결과와 조직검사 결과를 비교 분석하였다. 자료 분석은 chi-square test를 이용하였다. 결과 : 부적정 검체 (unsatisfactory) 및 제한적 적정 검체 (satisfactory but limited by: SBLB)의 결과가 고식적인 방법의 세포진 검사에서 더 많이 발생하였으나 통계학적으로 유의한 차이는 없었다. 두 검사간의 ASCUS/LSIL의 비는 MonoPrepⓇ 방법을 이용하였을 때 1.9에서 0.4로 78.9%의 의미있는 감소를 보였다 (P<0.001). 또한 자궁경부 이상 병변의 진단에 있어서 고식적인 세포진 검사는 민감도 87.7%, 양성 예측도 82.3%, 위음성률 10.3%를 보였으며 MonoPrepⓇ 검사는 민감도 94.8% (P=0.04), 양성 예측도 97.4% (P<0.001), 위음성율 2.6% (P=0.016)를 보였다. 결론 : MonoPrepⓇ 세포진 검사는 자궁경부 이상 병변을 진단하는데 있어 고식적인 방법보다 높은 민감도와 낮은 위음성율을 보이는 유용한 방법이다.
Abstract
Objective : To compare the specimen adequacy and cytologic diagnostic results of MonoPrepⓇ, a type of liquid based preparation, with the conventional Pap smear. Methods : In randomly selected 156 patients who visited the department of Obstetrics and Gynecology, Ajou University Hospital for cervical biopsy, conventional Pap smear and matched MonoPrepⓇ were performed. Statistical analysis was performed with chi-square test. Results : There were more “Unsatisfactory” and “Satisfactory but limited by (SBLB)” results in the conventional Pap smear group, even though no statistical significance could be found between the two groups. ASC/LSIL ratio was significantly decreased in the MonoPrepⓇ group, showing 0.4 with MonoPrepⓇ and 1.9 with conventional Pap smear demonstrating a 78.4% decrease (P<0.001). In detecting abnormal cervical lesions, conventional pap smear showed a sensitivity of 87.7%, positive predictability of 82.3%, false negativity of 10.3%, while MonoPrepⓇ showed a sensitivity of 94.8% (P=0.04), positive predictability of 97.4% (P<0.001), and false negativity of 2.6% (P=0.016). Conclusion : MonoPrepⓇ is more effective for the detection of cervical lesions with higher sensitivity and lower false negativity compared to conventional pap smear.
참고문헌 (27)
- Devesa S.S, "Recent trends in cervix uteri cancer.", Cancer, 64, pp.2184~2190 (1989)
- Pretorius R, "Presentation of cervical cancer.", Gynecol Oncol, 42, pp.48~53 (1991)
- Montz F.J, "Impact of Increasing Papanicolaou Test Sensitivity and Compliance: A Modeled Cost and Outcomes Analysis.", Obstet Gynecol, 97(5), pp.781~788 (2001)
- Boffetta P, "Cancer in developing countries.", Cancer J Clin, 44, pp.81~90 (1994)
- 목정은, "자궁경부암 환자 1058예의 임상적 분석", Obstetrics & Gynecology Science, 44(1), pp.101~113 (2001), 대한산부인과학회
- Gay J.D, "False-negative results in cervical cytologic studies.", Acta Cytol, 29, pp.1043~1046 (1985)
- Dodd L.G, "Quality-assurance study of simultaneously sampled non- correlating cervical cytology and biopsies.", Diagn Cytopathol, 9, pp.138~144 (1993)
- Vooijs G.P, "The influence of sample takers on cellular composition of cervical smears.", Acta Cytol, 30, pp.251~257 (1985)
- 김대곤, "자궁경부 세포진 검사에서 기존의 방법과 ThinPrep 법의 비교 연구.", 대한산부회지, 43, pp.1450~1458 (2000)
- Bolick D.R, "Laboratory implementation and efficacy assessment of the ThinPrep cervical cancer screening system.", Acta Cytol, 42, pp.209~213 (1998)
- Aponte-Cipriani S.L, "Cervical smears prepared by an automated device versus the conventional method: A comparative analysis.", Acta Cytol, 39, pp.623~630 (1995)
- Ferenczy A, "Diagnostic performance of Hybrid Capture human papillomavirus deoxyribonucleic acid assay combined with liquid-based cytologic study.", Am J Obstet Gynecol, 175, pp.651~656 (1996)
- Sherman M.E, "Cervical specimens collected in liquid buffer are suitable for both cytologic screening and ancillary human papillomavirus testing.", Cancer(Cancer Cytopathol), 81, pp.89~97 (1997)
- Tezuka F, "Diagnostic efficacy and validity of the ThinPrep method in cervical cytology.", Acta Cytol, 40, pp.513~518 (1996)
- Smith J.H, "Bethesda 2001, review.", Cytopathol, 13(1), pp.4~10 (2002)
- Ferenczy A, "Conventional cervical Cytologic smears vs. ThinPrep smear. A paired comparison study on cervical cytology.", Acta Cytol, 40, pp.1136~1142 (1996)
- Carpenter A.B, "ThinPrep Pap Test: Performance and biopsy follow-up in a university hospital.", Cancer(Cancer Cytopathol), 87, pp.105~112 (1999)
- Marino J.F, "Direct-to-Vial Experience with AutoCyte Prep in a small New England Regional Cytology Practice.", J of Reprod Med, 46, pp.353~358 (2001)
- Vassilakos P, "Direct-to-vial use of the AutoCyte PREP liquid-based reparation for cervical-vaginal specimens in three European laboratories.", Acta Cytol, 43, pp.65~68 (1999)
- Lee K.R, "Comparison of Conventional Papanicolaou Smears and a Fluid-based, Thin-Layer System for Cervical Cancer Screening.", Obstet Gynecol, 90(2), pp.278~284 (1997)
- Bishop J.W, "Multicenter Masked Evaluation of AutoCyte Prep Thin Layers with Matched Conventional Smears.", Acta Cytol, 42, pp.189~197 (1998)
- Willima T, "Preliminary Assessment of the AutoCyte PREP. Direct-to-vial performance.", J of Reprod med, 45, pp.912~916 (2000)
- Obwegeser J.H, "Does liquid-based technology really improve detection of cervical neoplasia? A prospective, randomized trial comparing the ThinPrep Pap Test with the conventional Pap Test, including follow-up of HSIL cases.", Acta Cytopathol, 45(5), pp.709~714 (2001)
- Hutchinson M.L, "Utility of liquid-based cytology for cervical carcinoma screening: Results of a population-based study conducted in a region of Costa Rica with a high incidence of cervical carcinoma.", Cancer(Cancer Cytopathol), 87, pp.48~55 (1999)
- Weintraub J, "Efficacy of a Liquid-Based Thin Layer Method for Cervical Cancer Screening in a Population With a Low Incidence of Cervical Cancer.", Diagn Cytopathol, 22(1), pp.52~59 (2000)
- Sheets E, "Colposcopically directed biopsies provide a basis for comparing the accuracy of ThinPrep and Papanicolaou smears.", J Gynecol Tech, 1, pp.27~33 (1995)
- Linder J, "ThinPrep Papanicolaou testing to reduce false- negative cervical cytology.", Arch Pathol Lab Med, 122, pp.139~144 (1998)