임신 시 비정상 자궁경부 세포진 검사를 보이는 여성에 대한 임상적 고찰 (Clinical review of abnormal cervical cytology in pregnancy)

서지정보

· 발행기관 : 대한주산의학회
· 수록지 정보 : Perinatology / 19권 / 2호 / 167 ~ 173페이지
· 저자명 : 정순지, 서성숙, 김정혜, 옥순애, 문은정

초록

Purpose : This study was performed to evaluate the clinical significance of abnormal cervical cytology in pregnancy and the effectiveness of cytologic and colposcopic surveillance of these women.
Methods : A retrospective analysis was conducted in pregnant women referred to the colposcopic clinic with abnormal cervical cytologic results above ASCUS between Jan. 2002 and Dec. 2007. The Initial colposcopy was performed at the end of 1st trimester. Cervical cytology and colposcopy were repeated once or twice during remaining period of pregnancy and at postpartum 6~8 weeks. Colposcopy directed cervical biopsies were taken in case of colposcopic abnormalities. Without evidence of invasion, no invasive procedure was attempted during pregnancy. Above CIN2 patients were treated postnatally. The postpartum diagnoses were compared to the worst antepartum impressions and initial cytologies.
Results : One hundred three pregnant women were referred to colposcopic clinic for 5 years. There was no invasive cervical cancer antenatally. After delivery, 53 patients were followed up and 17 patients above CIN2 lesions treated. Two microinvasive squamous cell carcinoma and 1 invasive adenocarcinoma were found postnatally. In 33 initial ASCUS cytologies, there were 7 CIN2,3 lesions and 3 invasive cancers. One CIN3 was found in 13 LSIL cytologies. All 7 HSIL patients had CIN3 lesions. There were 2 microinvasive cancers postnatally in 17 antenatal CIN2,3 patients.
Conclusion : ASCUS cervical cytologic results in pregnancy have 30% possibility of CIN2,3 and cancer. LSIL results are normal in 85% and HSIL group 100% CIN3. Even though there is 12.5% risk of microinvasion in antenatal CIN2,3 lesions, noninvasive conservative management is reasonable.

영어초록

Purpose : This study was performed to evaluate the clinical significance of abnormal cervical cytology in pregnancy and the effectiveness of cytologic and colposcopic surveillance of these women.
Methods : A retrospective analysis was conducted in pregnant women referred to the colposcopic clinic with abnormal cervical cytologic results above ASCUS between Jan. 2002 and Dec. 2007. The Initial colposcopy was performed at the end of 1st trimester. Cervical cytology and colposcopy were repeated once or twice during remaining period of pregnancy and at postpartum 6~8 weeks. Colposcopy directed cervical biopsies were taken in case of colposcopic abnormalities. Without evidence of invasion, no invasive procedure was attempted during pregnancy. Above CIN2 patients were treated postnatally. The postpartum diagnoses were compared to the worst antepartum impressions and initial cytologies.
Results : One hundred three pregnant women were referred to colposcopic clinic for 5 years. There was no invasive cervical cancer antenatally. After delivery, 53 patients were followed up and 17 patients above CIN2 lesions treated. Two microinvasive squamous cell carcinoma and 1 invasive adenocarcinoma were found postnatally. In 33 initial ASCUS cytologies, there were 7 CIN2,3 lesions and 3 invasive cancers. One CIN3 was found in 13 LSIL cytologies. All 7 HSIL patients had CIN3 lesions. There were 2 microinvasive cancers postnatally in 17 antenatal CIN2,3 patients.
Conclusion : ASCUS cervical cytologic results in pregnancy have 30% possibility of CIN2,3 and cancer. LSIL results are normal in 85% and HSIL group 100% CIN3. Even though there is 12.5% risk of microinvasion in antenatal CIN2,3 lesions, noninvasive conservative management is reasonable.

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