�l�@�c�@�V�@�١@���@�ˡ@�d
�@�@�@�O�Ĩ��l�c�V�γ��D������鸨�ӭM�Ұ����ˬd�C�����ܥX�l�c�V���L�P�V�B�o���B���`�ӭM�άO���g�o�ͤ��i��C
���ֵ��ˬd�i�H�o�{�l�c�B���D�B�Z�_�B��Z�ޡB�H�֤Ϊ��z�O�_���~������n�W�����`�C
�s���l�c�V���b�g�L�v����s���v���F99�M�C
�ָӰ��l�c�V�٤��ˬd�H
? �Z�O�w���ʸg�窺�k��
? �l�c�V�٤��ˬd�S�������˪��~�֤W���C
? ���L�l�c���������k���٬O�ݩM��v�Q�O�_�~��w�����l�c�V�٤��ˬd�C
�l�c�V�٤��ˬd���ɶ��Ϊ`�N�ƶ�
? �̾A�X���l�c�V�٤��ˬd���ɶ��O��g�g���}�l�᪺��10-20�Ѥ��C
? �ˬd�e��ѥ����קK���D�R�~�B�ϥγ��D�뾯�B�����ξ��μ��ƾ��C
? �e�@�ߤ���ʦ欰�A�]�Шƫ�A�j�q��l�Ӽv�T�PŪ�C
�l�c�V�٤��ˬd���i������
1991�~���s�שw�L��Bethesda System�C�䤺�e�p�U�G
Bethesda System�G�٤��PŪ���G
? �٤��~��G(1)�}�n (2)�|�i (3)�٤����H�PŪ
? �٤��|�i�����H�PŪ����]�G
1. �٤��T�w�ΫO�s���}
2. �ӭM�Ӥ�
3. �ӭM�ӫp�Φ�G�Ӧh
4. �S���l�c���V����
5. ���g�ӭM�L�h
6. �s�b�~�Ӫ�(�p���ƾ�)
7. �L�h�ӭM���ѩΦ۷�
8. ��L
? �i��P�V
1. Candida ���]��
2. Trichomonas ���D�w��
3. Herpes �p�l�f�r
4. Human papilloma virus �H���Ŭ𪬯f�r
5. Chlamydiae ���۵�
6. Others �䥦
? �ӭM�f�z�E�_
NORMAL(WITHIN NORMAL LIMIT) ���`�]�b���`���d���^
Normal ...................................................................................................................... (1)
Reactive changes: Inflammation, repair, radiation, and others .................................. (2)
Atrophy with inflammation ....................................................................................... (3)
AYPICAL CELLS OF UNDETERMINED SIGNIFICANCE
�D�嫬�쪬�W�ֲӭM���N�q������
Atypical squamous cells ............................................................................................ (4)
Atypical glandular cells ............................................................................................. (5)
LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL)
�C���쪬�W�֤��f�_
HPV-related changes ................................................................................................. (6)
Mild dysplasia (CIN 1) .............................................................................................. (7)
HIGH-GRADE SQUAMOUS INTRAEPITHELIAL LESION (HSIL)
�����쪬�W�֤��f�_
Moderate dysplasia (CIN 2) ...................................................................................... (8)
Severe dysplasia (CIN 3) .......................................................................................... (9)
Carcinoma in situ (CIN 3) ........................................................................................ (10)
SQUAMOUS CELL CARCINOMA �쪬�ӭM�� ................................................ (11)
ADENOCARCINOMA ���� .................................................................................. (12)
NON-EPITHEIAL NEOPLASM �D�W�֩��ؽF .................................................. (13)
OTHERS �䥦 .......................................................................................................... (14)
Atypical glandular cells favor neoplasm .................................................................. (15)
Atypical squamous cells favor HSIL ........................................................................ (16)
Dysplasia, favor HSIL .............................................................................................. (17)
�l�@�c�@�V�@�W�@�֡@���@�`�@�W�@��
�@�@CIN (cervical intraepithelial neoplasia)�A���l�c�V�W�ֲ��`�W�͡C�b�l�c�V���W�ֳ��줺�������`���ӭM�s�b�CCIN�b��´�ǤW�i����3�šACIN I�AII�AIII�O�Ѩ䲧�`�ӭM�Ҧs�b���h���Ӥ��CCIN²��Ө��N�O�l�c�V���g�e���A�]�N�O���٤��D�n�������e�f�A�]���p�ভ���ˬd�X��CIN�A�N�i���Ǹ��O�u�B���īD�`�n���v���C��CIS�]carcinoma in situ�^�h�O������A�����g�ӭM������h���W�ֲӭM�h�ɡA�٬�������A�]�٬��l�c�V�s�����C��������ಾ�M�O���ಾ�����v���D�`���p�A�i�Τl�c�V�@�������Τl�c��������N�v��.
�@�@�H���Ŭ𪬯f�r�O������ͬЪ��@�دf�r�C�䤤30�ط|�Ϥl�c�V���P�V�A�Ӧ���15�دf�r�P�l�c�V�������C�H���Ŭ𪬯f�r�O�l�c�V�����D�n�M�I�]�l�C�ëD�Ҧ��P�V�H���Ŭ𪬯f�r���w�̬ҷ|�ɭP���g�C�H���Ŭ𪬯f�r�P�V���`�o�ͦb�~�����H�f���A�S�O�b�C�K���ΤG�Q�X���k�ʨ��W�C�o�ǯf�r�q�`�|�����A���O�b�P�V��Ʀ~�٥i��|�Q�����X�C�j�����O�P�V�M�l�c�V���������H���Ŭ𪬯f�r�|�W�[���L���`�i�i���Y�����`�Τl�c�V�����M�I�ʡC
�@�@�ѩ�s��Bethesda�t�θ��ॿ�T���P�_�ӭM�����`�ʩM�����{����v�����Ϊ��T���A�ثe�X�G�w���NPap smear���t�ΡC
�bBethesda�t�Τ��������`�ӭM�����������G
�@�B�D�嫬�쪬�ӭM
�]atypical squamous cells of undetermined significance�A²��ASCUS�^
�G�B�C�ת��h�쪬�ӭM�f��
�]low grade squamous intraepithelial lesion�A²��LGSIL�^
�T�B���ת��h�쪬�ӭM�f��
�]high grade squamous intraepithelial lesion�A²��HGSIL�^
�@�@��CIN I�ܦ��l�c���I�ǩ����g�������A�@��Ө��O5��10�~���ɶ��C
�@�@��CIN I��CIN II����6�~�A
�@�@CIN II��CIN III�h��3�~���k���ɶ��A
�@�@CIN III���ܬ��l�c�V������1�~���ɶ��C
�@�@�@�@�@�@�@�h�� �@�@�@���� �@�@�@�i������� �@�@�i���Iŧ��
--------------------------------------------------------------------------------
�@�@CIN I �@�@�@57% �@�@�@32% �@�@�@�@�@11%�@�@�@�@�@�@�@ 1%
�@�@CIN II�@�@�@ 43% �@�@�@35% �@�@�@�@�@22% �@�@�@�@�@�@�@5%
�@�@CIN III �@�@32% �@�@�@<56%�@�@�@�@�@ - �@�@�@�@�@�@�@�@>12%
--------------------------------------------------------------------------------
�@�@�@�@�@�@�ӭM�f�z�@�@�@�@�@�@�@�@�@�@�@ �B�m�P��ij
--------------------------------------------------------------------------------
���`�ӭM�ܤơ@�@�@�@�@�@�@�@�@�@�@�@�@�@�@ �����B�m
(1) Normal
(2) Reactive changes�@�@�@�@�@�@�@�@�@�@�@�@�@�@��O�u�v���A�l�ܧY�i
(3) Atrophy with inflammation �@�@�@�@�@�@�@�@�@HRT
�D�嫬�ӭM
(4) ASUCS
(5) AGUS �@�@�@�@�@�@�@�@�@�@�@�@�@�@�@�@�@�T�Ӥ�᭫�@�٤��H�ΧY�ɰ����D���ˬd
�C�פW�ֲӭM�f�_�]LSIL�^
(6) Mild dysplasia (CIN 1) �@�@�@�@�@�@�@�@�@�@�@�T�Ӥ�᭫�@�٤��H�ΧY�ɰ����D���ˬd
���פW�ֲӭM�f�_�]HSIL�^
(7) Moderate dysplasia(CIN 2)
(8) Severe dysplasia(CIN 3)
(9) Carcinoma in situ(CIN 3) �@�@�@�@�@�@�@�@�@�@���D���ˬd�ίf�z�����ˬd
���g�f��
(10) Squamous cell carcinoma
(11) Adenocarcinoma
(12) Other malignant neoplasm �@�@�@�@�@�@�@�@�@���D���ˬd�ίf�z�����ˬd
��L
(15)Atypical glandular cells favor neoplasm �@�@�@�@���D���ˬd�ΰ�ECC
(16)Atypical squamous cells favor HSIL
(17)Dysplasia, favor HSIL �@�@�@�@�@�@�@�@�@�@�@���D���ˬd�ίf�z�����ˬd
--------------------------------------------------------------------------------
CIN���v��
�q�N�v��, �N��v��, �p�g�v��, LEEP, �l�c�V�@������,�l�c����
�l�@�c�@�V�@��
�@�@�k�ʤl�c�V���ӭM�i��]���������E�ηP�V�ӵo�ͤ@�s�ꪺ���g����. ���`���d���l�c�V�ӭM�|�]�����ܱo���`�W�͡A�ӴN���i�����ܬ��������l�c�V���ӭM�C�l�c�V�������]�ثe�Q�o�{�i���ǥѩʥ�P�V�H���Ŭ𪬯f�r�����ܬ��l�c�V���ӭM�C�wHPV�P�V���|�������k�ʡA�۹諸�]�����o��l�c�V���C�l�c�V���O�`�������k���g�A�ھڲέp��ܡG�l�c�V���o�Ͳv���ƦW���k�����g�Ĥ@��A�U�Ӧ~�ּh���k�ʳ����i��o�ͤl�c�V���A���H25����45�������k�̬��`���C���`�v���ƦW�h���k�����g���ĥ|��A���`�H�Ʀ��������g���`�H�ƪ�4%�C
�l�c�V�����i��f�] (�@)�G
1. ���B���C�K���k�l�A�ѩ��l�c�V���W���w�쪬�W�֤��B��������ܤƴ��A�]���b�ʦ欰����E�U�e���o���ܤơC���Φ��i���B�~�a�ѵ��ֻ�(DNA) �����b�ഫ���l�c�V�W���w�쪬�W�ֲӭM�A�y����V���骺�����`�M���o���g�����͡C
2. �o�L�ʯf�r��
3. �H���Ŭ�f�r�G�o�{�H���Ŭ�f�r�ĤQ�����b�l�c�V���ӭM�������P�V�v(51�H)�A�Ӧb���`���l�c�V�ӭM����16�����P�V�v�u��2.6 �H�C�G�B�f�A�Ͳz��
�l�c�V���i��f�] (�G)�G
1. �ʥͬ��G
2. �~�֡G35?45���O�l�c�V�����n�o�~�֡C
3. �ʯf�P�V�G
4. �l�c�V�o���G
5. �l�ϡG
6. ���|�P�رڡG
7. �k�ʲ����X�G
�l�c�V�����g��
�@�@�@�s�����l�c�V���b�{�ɤW�����S���S������ı�g���A���j�h�Ƴ��O�b�Ҧ檺�l�c�V�٤��ˬd�N�~�a�Q�o�{�X�ӡC�w�̱`�`�O�S���g�����C�q�`�n���ܦ��F�I�ǩʪ��l�c�V���ɯg���~�|��ܥX�ӡC�̱`�����g���O�ʥ��X��A���D�����`���X��A�δc�䪺���D���c���C�l�c�V�ӭM���`�W�ͩM�����l�c�V���i�Ǥl�c�V�٤��ˬd�����X�ӡA���p�G�l�c�V���I�Ǩ�l�c���{���`��´�M���ֵľ������g�ɡA�h�|���������g�h�B�U���k�h�B�Φ]��������(�i��O�~�F�����駿��)�ӳy���Ǫ��n�����{�H�C�ߴ����l�c�V�����F���D�X��~�A�`�|���y�h�B�U�ϵh���g���A�o�D�n�O�~�F�I�Ǩ�駿�ޡB���־��Χ������g�ҭP�C�����f�H�]�O���ಾ��ê��O�ڲG���`���A�ٷ|���U�Ϥ��~���{�H�C�������f�H�]�~�F�I�Ǩ�c���t�ΩΪ��z�A�����ٷ|�����ͦ姿�B��K���{�H�A�̫�]�駿�ު���Өֵo�Ǥ��~�B���r�g�C���M�A�xŦ�B��Ŧ�ί�հ��]���O�`�����l�c�V���ಾ��m�C
�l�c�V�����f�z�����j�O�p�U�G
1.�쪬�W�֩����W����(Squamous Cell Carcinoma��EpidermoidCarcinoma)�G�䤤�S�i����
(1) ����ƩΫD����ƪ��j�ӭM(keratinizing ornonkeratinizing large cell)
(2) �p�ӭM(small cell)
(3) �����W����(Verrous)
�@�쪬�W�����e�F94.9�H�A�䤤�j�������D����ƪ��j�ӭM�C
2.����(Adenocarcinoma)�G
�@�������̨嫬���O�l�c���V��������(endocervical pattern)�A�䥦�٦����֨������G�ӭM����(Clear cell)�B�n��������(Adenoid cystic) �δc�ʡA���~(Adenoma malignum)�C�������e�l�c�V����4.8-5.7�H�A�ѩ����O�q�l�c���V�X�ӡA���E�_�ɩ����w�����j���~�F�βO���ಾ�A�[�W�������g�u�v�����ĪG�S���쪬�W�����ӱo��ۡA�]���@��ӻ��A�������w����t�C
3.��������(Adenoacanthoma)�G
�@�N�O�t���쪬�W�֤θ�����ئ������l�c�V���C���e�l�c�V���� 0.3 �H�C
4.�䥦�G
�@�����֨��A�p����(carcinoid) �B�F(sarcoma) �B�βO�ڽF(lymphoma)���C
�l�c�V�����{�ɤ���(staging)�G
1. �{�ɤ���
A.�s���l�c�V���w�w
�@�S�٬�������A���ӭM���]����W�֤��A�|����}��(basement membrane)�C
B.�Ĥ@��(stage I )�w�w
�@���g�u�]���b�l�c�V�A�Ѩ�I�ǵ{�ת��`�L�A�S�����Ĥ@���W(Ia)�P�Ĥ@���U(Ib)�C�Ĥ@���W�������ӭM�w��z���Ө�F����ӭM�A���O�٬۷������A�u�����L�������A�S�٬���L�ʫI��(microinvasive)�C��I�Dz`�������W�L5mm �A�����I�ǽd�������W�L7mm�C�p�W�L���d��Ӥ��]���b�l�c�V�A�h��O�@���U���l�c�V���C
C.�ĤG��(stage II)�w�w
�@���g�V�U�Iŧ��F���D�A���O������F���D���U1/3 �]���٬��ĤG���W�^�A�Ϊ̩�����V�ⰼ���l�c��´(parametrium) �I�ǡA���|����F���־��]���k�����ĤG���U)�C
D.�ĤT��(stage III) �w�w
�@���ӭM���U�Iŧ��F���D���U�T�����@�]���٬��ĤT���W�^�ΫI�Ǩ�F���־��]���٬��ĤT���U)�C
E.�ĥ|��(stage IV)�w�w�w
�@���g�w�W�X�ʹD�C�p�I�Ǩ�H�֩Ϊ��z���H���h�k�����ĥ|���W�A�p�����ֵĥ~�������ಾ�A�h�k�����ĥ|���U�C