出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2013/12/05 09:28:04」(JST)
The Bethesda system (TBS) is a system for reporting cervical or vaginal cytologic diagnoses,[1] used for reporting Pap smear results. It was introduced in 1988,[2] and revised in 1991 [3] and 2001.[4][1][5] The name comes from the location (Bethesda, Maryland) of the conference that established the system.
Abnormal results include:
Low grade squamous intraepithelial lesion (LSIL or LGSIL) indicates possible cervical dysplasia. LSIL usually indicates mild dysplasia (CIN 1), more than likely caused by a human papillomavirus infection. It is usually diagnosed following a Pap smear.
CIN 1 is the most common and most benign form of cervical intraepithelial neoplasia and usually resolves spontaneously within two years. Because of this, LSIL results can be managed with a simple "watch and wait" philosophy. However, because there is a 12–16% chance of progression to more severe dysplasia, the physician may want to follow the results more aggressively by performing a colposcopy with biopsy.[6] If the dysplasia progresses, treatment may be necessary. Treatment involves removal of the affected tissue, which can be accomplished by LEEP, cryosurgery, cone biopsy, or laser ablation.
High grade squamous intraepithelial lesion (HSIL or HGSIL) indicates moderate or severe cervical intraepithelial neoplasia or carcinoma in situ. It is usually diagnosed following a Pap test. In some cases these lesions can lead to invasive cervical cancer, if not followed appropriately.
HSIL does not mean that cancer is present. Of all women with HSIL results, 2%[7] or less[8] have invasive cervical cancer at that time, however about 20% would progress to having invasive cervical cancer without treatment.[9] To combat this progression, HSIL is usually followed by an immediate colposcopy with biopsy to sample or remove the dysplastic tissue. This tissue is sent for pathology testing to assign a histologic classification that is more definitive than a Pap smear result (which is a cytologic finding). HSIL generally corresponds to the histological classification of CIN 2 or 3.
HSIL treatment involves the removal or destruction of the affected cells, usually by LEEP. Other methods include cryotherapy, cautery, or laser ablation, but none are performed on pregnant women for fear of disrupting the pregnancy.[10] Any of these procedures is 85% likely to cure the problem.
Adenocarcinoma can arise from the endocervix, endometrium and extrauterine sites.
AGC, formerly AGUS, is an acronym for atypical glandular cells of undetermined significance.[11] Renamed AGC to avoid confusion with ASCUS.[1]
The management of AGC is colposcopy with or without an endometrial biopsy.[citation needed]
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リンク元 | 「子宮頚癌」「軽度扁平上皮内病変」 |
関連記事 | 「LS」「LSILs」 |
ベセスダシステム | 推定病変 | 用語説明 | 日母分類 |
NILM | 非腫瘍性病変, 炎症 | 陰性 | I/II |
ASC-US | 軽度扁平上皮内病変(LSIL)疑い | 意義不明異型扁平上皮 | II/IIIa |
ASC-H | 高度扁平上皮内病変(HSIL)疑い | 高度病変を除外できない異型扁平上皮 | III/IIIb |
LSIL | HPV感染, 軽度異形成 | 軽度扁平上皮内病変 | IIIa |
HSIL | 中等度異形成, 高度異形成, 上皮内癌 | 高度扁平上皮内病変 | IIIa, IIIb, IV |
SCC | 扁平上皮癌(微小浸潤含む) | 扁平上皮癌 | V |
AGC | 腺異形成, 腺系病変疑い | 異型腺細胞 | III |
AIS | 上皮内腺癌 | 上皮内腺癌 | IV |
adenocarcinoma | 腺癌 | 腺癌 | V |
other | その他のがん | その他の悪性腫瘍 | V |
子宮頸癌 | 0期(上皮内癌) | 上皮内癌 | ・円錐切除(挙児希望) ・円錐切除or単純子宮全摘術(挙児希望なし) | ||
I期 子宮頚部に限局 |
Ia期 微小浸潤癌 |
Ia1期 | (微小浸潤癌) 病理組織 間質浸潤 深さ3mm以内 幅7mmを超えない |
・円錐切除(挙児希望) ・単純子宮全摘術(挙児希望なし) | |
Ia2期 | (微小浸潤癌) 病理組織 間質浸潤 深さ3-5mm以内 幅7mmを超えない |
・(準)広汎子宮全摘術+骨盤リンパ節郭清術 ・広汎子宮全摘術 | |||
Ib期 | Ib1期 | 4cm以下 | ・広汎子宮全摘術 | ||
Ib2期 | 4cmを超える | ・広汎子宮全摘術 ・放射線療法 ・同時科学放射線療法 | |||
II期 頸部を超えて進展かつ 骨盤壁or膣壁下1/3に達しない |
IIa期 | 膣壁浸潤のみ | ・広汎子宮全摘術 ・放射線療法 ・同時科学放射線療法 | ||
IIb期 | 子宮傍組織浸潤のみ | ・広汎子宮全摘術 ・放射線療法 ・同時科学放射線療法 | |||
III期 骨盤壁に達するor 膣壁浸潤下1/3 |
IIIa期 | 膣壁浸潤下1/3 | ・放射線療法 ・同時科学放射線療法 | ||
IIIb期 | 骨盤壁に達する | ・放射線療法 ・同時科学放射線療法 | |||
IV期 膀胱,直腸の粘膜へ浸潤or 小骨盤を超えて進展 |
IVa期 | 膀胱,直腸の粘膜へ浸潤 | ・放射線療法 ・同時科学放射線療法 | ||
IVb期 | 小骨盤を超えて進展 | ・放射線療法 ・化学療法 |
進行期 | 外部照射(Gy) | 腔内照射(Gy/ 回,A点線量) | ||
全骨盤 | 中央遮蔽 | |||
Ⅰ | 0 | 45~50 | '29/5 | |
Ⅱ | 小 | 0 | 45~50 | '29/5 |
大 | 20 | 30 | '23/4 | |
Ⅲ | 小~中 | 20~30 | 20~30 | '23/4 |
大 | 30~40 | 20~25 | '15/3~20/4 | |
ⅣA | 30~50 | 10~20 | '15/3~20/4 |
病期 | 症例数 | 5年相対生存率 |
I期 | 1137 | 92.1% |
II期 | 447 | 69.8% |
III期 | 428 | 48.9% |
IV期 | 151 | 17.2% |
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