許維邦 1,2,3 張瑞月 4,5 蕭培靜 6,7 林佳臻 1 33 Pap smear 30 The Bethesda System(TBS) [1,2] 1970 1 澄清綜合醫院家庭醫學科 2 國立台中科技大學中護健康學院護理系 3 台中市東區衛生所 4 嘉義基督教醫院內科部心臟內科 5 敏惠醫護管理專科學校美容專業保健科 6 中山醫學大學醫學系 7 中山醫學大學附設醫院內科部血液腫瘤科 Pap smear, the Bethesda system, speculum, inadequate specimen, pelvic examination. 103 The Bethesda System TBS TBS 1988 12 Bethesda 1, 2, 3, 4, 5 dysplasia: mild, moderate, severe, etc TBS 239
TBS TBS 1988 squamous intraepithelial lesions-sils low-grade SIL LSIL high-grade SIL HSIL statement of adequacy 1991 TBS TBS specimen adequacy 2001 TBS 2000 the 2001 Bethesda System Terminology 2014 TBS interpretation result diagnosis ; TBS [1,2] TBS 21 抹片採樣和內診的技巧 (speculum insertion) [12] 1 240
圖 1 無帳幕 ( 圖 a) 與有帳幕 ( 圖 b) 的婦科內診 圖 a [3-6] 圖 b 2 squamocolumnar junction SCJ 3 360 [7] 80% KY jelly 241
圖 2 各種不同子宮頸抹片採樣棒 圖 3 子宮頸抹片採樣位置 (a) (b) 鱗狀柱狀上皮交會處 (SCJ) (a) 曾經陰道分娩之生育期婦女 ( 外翻之子宮頸 ) (b) 未曾有經陰道分娩之生育期婦女或是更年期後之婦女 (SCJ 內縮 ) 242
243 抹片採樣標本難以判讀個案之處理 1 2 3 4 5 6 7 8 4 6 KY jelly 抹片檢查與全民健康保險給付制度 30 1 30 104 6
抹片檢查與人類乳突病毒偵測 [8, 9] 結論 參考資料 1. Nayar R, Wilbur DC: The Pap smear and Bethesda 2014. Acta Cytologica 2015; 59:121-32. 2. Solomon DL: Forward. In: Nayar R, Wilbur D: The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. 3rd ed. New York: Springer 2015. 3. Wolfberg AJ: The patient as ally learning 244
the pelvic examination. N Engl J Med 2007; 356:889-90. 4. Moore A: Her first pelvic examination: helpful hints for the practitioner. JNP 2007; 3:560-1. 5. Marie GO, Eva G B, Barbro E W: The first pelvic examination. J Psychosom Obstet & Gynecol 2007; 28:7-12. 6. Daley AM, Cromwell PF: How to perform a pelvic exam for the sexually active adolescent. Nurse Pract 2002; 27:28-43. 7. Martin-Hirsch P, Jarris G, Kitchener H et al.: Collection devices for obtaining cervical cytology samples. Cochrane Database Syst Rev 2000;3:cd001036. 8. Monsonego J: HPV testing in prevention of cervical cancer practice and current trends.(in French) Ann Biol Clin 2013;71:27-32. 9. Baker E: HPV and Pap: shifting roles in cervical cancer screening. MLO Med Lab Obs 2013; 45:24-26. 10. Larsen M, Oldeide CC, Malterudk: Not so bad after all, women s experiences of pelvic examination. Fam Pract 1997; 14:148-52. 11. Wijma B, Siwe K: Examiner s unique possibilities to catalyze women s empowerment during a pelvic examination. Acta Obstet Gynecol Scand 2004; 83:1102-3. 12. Hilden M, Sidenius K, Langhoff-Roos J et al: Women s experiences of gynecologic examination: factors associated with discomfort. Acta Obstet Gynecol Scand 2003; 82:1030-6. 245