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Cho A, Kim MY, Park IS, Park CM. A retrospective study for long-term oncologic and obstetric outcomes in cervical intraepithelial neoplasia treated with loop electrosurgical excision procedure: focus on surgical margin and human papillomavirus. BMC Womens Health 2024; 24:116. [PMID: 38347568 PMCID: PMC10863218 DOI: 10.1186/s12905-024-02923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The present study aimed to evaluate the long-term oncological and obstetric outcomes following the loop electrosurgical excision procedure (LEEP) in patients with cervical intraepithelial neoplasia (CIN) and investigate the risk factors for recurrence and preterm birth. METHODS This retrospective cohort study included patients who underwent LEEP for CIN 2-3 between 2011 and 2019. Demographic information, histopathological findings, postoperative cytology, and human papillomavirus (HPV) status were collected and analyzed. The Cox proportional hazards model and Kaplan-Meier curves with the log-rank test were used for risk factor analysis. RESULTS A total of 385 patients treated with the LEEP were analyzed. Treatment failure, including recurrence or residual disease following surgery, was observed in 13.5% of the patients. Positive surgical margins and postoperative HPV detection were independent risk factors for CIN1 + recurrence or residual disease (HR 1.948 [95%CI 1.020-3.720], p = 0.043, and HR 6.848 [95%CI 3.652-12.840], p-value < 0.001, respectively). Thirty-one patients subsequently delivered after LEEP, and the duration between LEEP and delivery was significantly associated with preterm-related complications, such as a short cervix, preterm labor, and preterm premature rupture of the membrane (p = 0.009). However, only a history of preterm birth was associated with preterm delivery. CONCLUSIONS Positive HPV status after LEEP and margin status were identified as independent risk factors for treatment failure in patients with CIN who underwent LEEP. However, combining these two factors did not improve the prediction accuracy for recurrence.
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Affiliation(s)
- Angela Cho
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju-si, Republic of Korea.
- Department of Obstetrics and Gynecology, College of Medicine, Jeju National University, Aran 13-gil, Jeju-si, Jeju-do, 63241, Republic of Korea.
| | - Min-Young Kim
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju-si, Republic of Korea
| | - In-Sun Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Min Park
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju-si, Republic of Korea
- Department of Obstetrics and Gynecology, College of Medicine, Jeju National University, Aran 13-gil, Jeju-si, Jeju-do, 63241, Republic of Korea
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Kim MJ, Lee GJ, Lee EJ, Lee S, Chay DB, Lee CH, Kim JH, Roh JW. Lugol's Solution Reduces Positive Margins and Residual Disease After the Large Loop Excision of Transformation Zone. J Low Genit Tract Dis 2024; 28:12-17. [PMID: 38032756 DOI: 10.1097/lgt.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether the intraoperative use of Lugol's solution reduces the proportion of positive resection margins (RMs) using the data of women who underwent large loop excision of the transformation zone (LLETZ). MATERIALS AND METHODS A total of 1,751 consecutive women with cervical intraepithelial neoplasia (CIN) who underwent LLETZ with or without Lugol's solution were retrospectively retrieved from each database of 3 university hospitals in South Korea. Outcomes included positive RMs and residual disease pathologically confirmed within 6 months after LLETZ. RESULTS Positive RMs were noted in 345 cases (19.7%). Among 1,507 women followed up, residual disease was diagnosed in 100 cases (6.6%) (69/308 cases with positive RMs; 31/1,199 cases with negative RMs). The Lugol's solution group was less likely to have positive RMs (11.8% vs 25.5%, p < .01), to require additional surgical intervention (5.4% vs 10.2%, p < .01), and to have residual disease (4.9% vs 8.0%, p = .02). On multiple logistic regression analysis, Lugol's solution reduced the proportion of positive RMs (adjusted odds ratio [aOR], 0.31). Age (50 years or older; aOR, 1.64), preconization cervical cytology (aOR, 1.53), high-risk human papillomavirus (aOR, 1.75), and CIN 2 or 3 (aOR, 2.65) were independent risk factors for margin positivity ( p < .01 for all except high-risk human papillomavirus of p = .05). CONCLUSIONS Lugol's solution optimizes CIN treatment by reducing the proportion of positive RMs and residual disease after LLETZ.
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Affiliation(s)
- Min-Jeong Kim
- Department of Obstetrics and Gynecology, CHA Hospital Ilsan Medical Center, Goyang-si, South Korea
| | | | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Seoul, South Korea
| | - Seungmee Lee
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Doo Byung Chay
- Department of Obstetrics and Gynecology, Sahmyook Medical Center, Seoul, South Korea
| | - Chae Hyeong Lee
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju-Won Roh
- Department of Obstetrics and Gynecology, CHA Hospital Ilsan Medical Center, Goyang-si, South Korea
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Mosseri J, Benoit L, Koual M, Nguyen-Xuan HT, Bentivegna E, Bats AS, Azaïs H. Margin status after loop electrosurgical excision procedure (LEEP) and laser excision in patients with high-grade cervical neoplasia. J Gynecol Obstet Hum Reprod 2024; 53:102707. [PMID: 38061495 DOI: 10.1016/j.jogoh.2023.102707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Early management of high-grade cervical intraepithelial neoplasia is one of the key steps in cervical cancer prevention after vaccination and screening. It relies on lesion removal by surgical excision, and the French National Cancer Institute (INCa) in 2016 recommend using a loop electro excision procedure (LEEP). However, the laser excision method seems to be as effective with similar rates of negative excision margins and postoperative clearance of HPV. OBJECTIVE The main objective of our study was to compare the laser excision method to LEEP by evaluating the quality of the surgical margins. We also studied factors associated with the status of the margins and the depth of cones. METHODS We conducted a retrospective unicentric study between 2009 and 2017. RESULTS Two hundred and thirty-one patients were included: 154 laser excisions and 77 LEEP. Negative surgical margin was achieved in 69.5 % of laser excisions and 72.7 % of LEEP (p = 0.649). Concerning factors predicting margin status, only a greater cone depth was associated with negative margins (OR: 0.91 (95 %CI: 0.84, 0.89); p = 0.02). The surgical technique was not found to be associated with the status of the margins (OR: 0.85 (95 %CI: 0.46,1.56); p = 0.61). Concerning factors predicting cone depth, only the LEEP was associated with a shorter cone depth (OR: 0.24 (95 %CI: 0.08, 0.69); p 0.008). Significant results are based on univariate analysis. CONCLUSION No difference was found between the two technics concerning the rate of negative margins. However, LEEP seems to be associated with shorter cone depth in this study.
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Affiliation(s)
- Juliette Mosseri
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France.
| | - Louise Benoit
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France; INSERM UMR-2 1124, Université Paris Cité, Paris, France
| | - Meriem Koual
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France; INSERM UMR-2 1124, Université Paris Cité, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France
| | - Enrica Bentivegna
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France
| | - Anne-Sophie Bats
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France; INSERM UMR-S 1147, Université Paris Cité, Centre de Recherche des Cordeliers, Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, 20, rue Leblanc 75908, Paris Cedex 15, Paris, France; INSERM UMR-S 1147, Université Paris Cité, Centre de Recherche des Cordeliers, Paris, France
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Deng L, Wang T, Chen Y, Tang X, Xiang D. A predictive model for residual lesions after LEEP surgery in CIN III patients. Front Med (Lausanne) 2023; 10:1326833. [PMID: 38148909 PMCID: PMC10751019 DOI: 10.3389/fmed.2023.1326833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Background and aims The residual lesions after Loop Electrosurgical Excision Procedure (LEEP) contributes to poor prognosis in patients with Cervical Intraepithelial Neoplasia Grade 3 (CIN3). The aim of this study is to establish an effective clinical predictive model for residual lesions in CIN3 patients after LEEP. Methods A retrospective analysis was performed on 436 CIN3 patients who underwent total hysterectomy within 3 months after LEEP. Based on the post-hysterectomy pathologic, the patients were divided into the no residual group and residual group. Clinical parameters were compared between the two groups, and univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for residual lesions in CIN3 patients after LEEP. Using R software, a nomogram model was established and its effectiveness was evaluated using calibration plots. Results There were 178 cases in the residual group and 258 cases in the no residual group. The two groups had no significant difference in general characteristics (p > 0.05). It was found that Post-LEEP follow-up HPV, Post-LEEP follow-up TCT, and the Gland involvement were independent risk factors for residual lesions in CIN3 patients after LEEP (all p < 0.05). The consistency index (C-index) of the nomogram model for predicting residual lesions was 0.975 (0.962-0.988). Conclusion The Post-LEEP follow-up HPV, Post-LEEP follow-up TCT, and Gland involvement are independent risk factors related to residual tissue after LEEP surgery in CIN3 patients. The constructed nomogram can effectively predict the presence of residual tissue after LEEP surgery in CIN3 patients and has good practical value.
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Affiliation(s)
- Lihui Deng
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
| | - Tiejun Wang
- Department of Gynecological Oncology, Wuxi Maternal and Child Health Hospital, Wuxi, China
| | - Ye Chen
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
| | - Xueli Tang
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
| | - Dajun Xiang
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
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Visioli CB, Iossa A, Gorini G, Mantellini P, Lelli L, Auzzi N, Pierro CD, Carozzi FM, Zappa M. The 5-year risk of recurrence of grade 2/3 cervical intraepithelial neoplasia after treatment in a population screening programme by human papillomavirus status: A cohort study in central Italy. J Med Screen 2023; 30:191-200. [PMID: 37229655 DOI: 10.1177/09691413231175630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES (a) To estimate the risk of recurrent cervical intraepithelial neoplasia, grade 2/3 or worse (CIN2+/CIN3+), lesions within 5 years of follow-up in human papillomavirus-negative/human papillomavirus-positive cohorts; (b) to assess whether certain risk factors can predict the recurrence of CIN2+/CIN3+ lesions; and (c) to provide recommendations for follow-up after treatment of cervical intraepithelial neoplasia, grade 2/3 to prevent cervical cancer. SETTING Organized cervical cancer screening programme in Central Italy. METHODS We included 1063 consecutive first excisional treatments performed between 2006 and 2014 for screening-detected cervical intraepithelial neoplasia, grade 2/3 lesions among women aged 25-65. The study population was divided into two groups according to the human papillomavirus test results performed 6 months after treatment: Human papillomavirus-negative and human papillomavirus-positive cohorts. The 5-year risk of developing cervical intraepithelial neoplasia, grade 2/3 or worse (CIN2+/CIN3+) was estimated using the Kaplan-Meier method and the Cox regression model. RESULTS Among 829 human papillomavirus-negative and 234 human papillomavirus-positive women, six (0.72%; three cervical intraepithelial neoplasia, grade 2, three cervical intraepithelial neoplasia, grade 3) and 45 (19.2%; 15 cervical intraepithelial neoplasia, grade 2, 30 cervical intraepithelial neoplasia, grade 3), respectively, developed CIN2+ recurrence within 5 years of follow-up. The cumulative risks for CIN2+ and CIN3+ were 0.9% (95% confidence interval: 0.4%-2.0%) and 0.5% (95% confidence interval: 0.1%-1.4%), respectively, for the human papillomavirus-negative cohort, and 24.8% (95% confidence interval: 18.5%-32.7%) and 16.9% (95% confidence interval: 11.4%-24.5%), respectively, for the human papillomavirus-positive cohort. Risk factors associated with increased risk of recurrence were both margins positive for the human papillomavirus-negative cohort, and positive margins, cervical intraepithelial neoplasia, grade 3 lesions, high-grade cytology and high viral load for the human papillomavirus-positive cohort. CONCLUSIONS Human papillomavirus testing can identify women at increased risk of recurrence and this supports a recommendation for its use in the post-treatment follow-up of cervical intraepithelial neoplasia, grade 2/3 lesions.
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Affiliation(s)
- Carmen Beatriz Visioli
- Clinical Epidemiology and Clinical Governance Support Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Anna Iossa
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Clinical Epidemiology and Clinical Governance Support Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Paola Mantellini
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Lisa Lelli
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Noemi Auzzi
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Carmelina Di Pierro
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Francesca Maria Carozzi
- Formerly Regional Laboratory for Cancer Prevention, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
| | - Marco Zappa
- Clinical Epidemiology and Clinical Governance Support Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), Florence, Italy
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Kulkarni A, Covens A, Durand N, Ghorab Z, Gien LT, Osborne R, Vicus D, Kupets R. Role of HPV in the Prediction of Persistence/Recurrence After Treatment for Cervical Precancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102171. [PMID: 37343621 DOI: 10.1016/j.jogc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES (1) To determine the role of human papillomavirus (HPV) testing after excisional treatment of cervical precancer. (2) To determine clinical factors associated with persistence of cervical precancer post-treatment. METHODS A retrospective chart review was conducted including patients who had a loop electrosurgical excision procedure (LEEP) for cervical precancer (cervical intraepithelial neoplasia 3/adenocarcinoma in situ/high-grade squamous intraepithelial lesions [HSIL]). All patients treated between 2016 and 2018 at a tertiary centre colposcopy unit were included. Persistence/recurrence of disease was defined as high-grade cytology or histology identified during the time of follow-up. Univariate and multivariate regression models were performed to identify factors associated with persistence/recurrence and HPV positivity at exit testing. RESULTS A total of 284 patients were included. The median follow-up time was 19 months. Of the LEEP specimens, 90.8% (n = 258) demonstrated HSIL and 3.9% (n = 11) had adenocarcinoma in situ. 28.5% (n = 81) of the LEEP specimens had positive margins. In follow-up, 72.9% had negative cytology, 17.6% had atypical squamous cells of undetermined significance/low-grade SIL, 1.8% had atypical squamous cells, HSIL cannot be excluded/low-grade SIL-H, and 6.7% had HSIL. At the final follow-up, 27.8% (n = 79) were HPV+. Overall rate of persistence/recurrence was 11.3% (n = 32); median time to persistence/recurrence was 6.5 months. Multivariate regression models demonstrated that follow-up HPV positivity (OR = 22.0) and positive margins (OR = 3.7) were significantly associated with persistence/recurrence. Similarly, in univariate regression models, positive margins were significant (OR = 2.2) for predicting HPV positivity in exit testing. CONCLUSIONS Persistence/recurrence of precancer can occur due to incomplete treatment of lesions by local excision and by the persistence of HPV infection. Surveillance strategies for women treated for cervical precancer require a risk-based approach and should rely on HPV testing.
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Affiliation(s)
- Anjali Kulkarni
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON
| | - Al Covens
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Nancy Durand
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - Lilian T Gien
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Ray Osborne
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Danielle Vicus
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Rachel Kupets
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON.
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Peng H, Liu W, Jiang J, Du H. Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design. BMC Womens Health 2023; 23:454. [PMID: 37641051 PMCID: PMC10464471 DOI: 10.1186/s12905-023-02568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. METHODS This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. RESULTS Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3-4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. CONCLUSIONS Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.
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Affiliation(s)
- Hongfa Peng
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Wencan Liu
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China
| | - Jingjing Jiang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang City, 050051, Hebei, China.
| | - Hui Du
- Department of Obstetrics and Gynecology, Second hospital of Hebei medical university, Shijiazhuang City, 050000, Hebei, China.
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Sun Y, He Y, Zhuoma M, Hua Z, Sun Z, Jiang N, Kong F, Xiao Z. Are "additional cuts" effective for positive margins in cervical conization? It varies according to the doctor. World J Surg Oncol 2023; 21:260. [PMID: 37612769 PMCID: PMC10463738 DOI: 10.1186/s12957-023-03119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND High-grade squamous intraepithelial lesion (HSIL) is a disease that is closely related to the development of cervical cancer. In clinical work, cold knife conization and a loop electrosurgical excision procedure (LEEP) are often selected for diagnosis and treatment. OBJECTIVE In this paper, we aimed to discuss additional cuts, a common practice in cervical conization, and determine whether the doctor's choice to use additional cuts in conization can reduce the occurrence of a positive cone margin. METHODS From January 2018 to October 2019, 965 patients underwent cervical conization at the First Affiliated Hospital of Dalian Medical University (Dalian, China). Of these, 174 were in the positive cone margin group, and 791 were in the negative cone margin group. Age, preoperative pathology, pathological results of conization, additional cuts, cone depth, and cone volume were studied. Additionally, the additional cut rate and the efficiency of doctors with a habit of additional cuts were analyzed. RESULTS Of the 965 patients included in the study, the median age was 41 years (range 35-50). Multivariable logistic regression analysis suggested that additional cuts (OR, 2.480; 95% CI 1.608 to 3.826; p = 0.01) and smaller cone depth (OR, 0.591; 95% CI, 0.362 to 0.965, p = 0.036) were independent risk factors for positive margins. Six of the 64 doctors who performed conizations had a habit of making additional cuts, and there was no positive correlation between their additional cut rate and their effective additional cut rate. CONCLUSION This study showed that a certain proportion of additional cuts can be effectively excised from the positive margin that cannot be removed in the initial conization. The practice of additional cuts in conization tends to be the personal habit of a small number of doctors.
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Affiliation(s)
- Yujie Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Graduate School of Dalian Medical University, Dalian, China
| | - Yingying He
- Department of Pathology, People's Hospital of Pingshan District, Shenzhen, China
| | - Mima Zhuoma
- Institute of High Altitude Medicine, People's Hospital of Naqu Affiliated to Dalian Medical University, Dalian, Tibet, China
| | - Zhengyu Hua
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhigang Sun
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Jiang
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fandou Kong
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
- Graduate School of Dalian Medical University, Dalian, China.
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Giannella L, Delli Carpini G, Di Giuseppe J, Gardella B, Bogani G, Monti E, Liverani CA, Roncella E, Raspagliesi F, Spinillo A, Vercellini P, Ciavattini A. Should attention be paid to the cone depth in the fully visible transformation zone? Retrospective analysis of 517 patients with cervical intraepithelial neoplasia grade 3. Int J Gynaecol Obstet 2023; 161:137-143. [PMID: 36263898 DOI: 10.1002/ijgo.14520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The predictors of positive endocervical margin (EM) and a cone-depth cutoff value are not established in the fully visible transformation zone (TZ). The present study aimed to assess the independent variables associated with positive EM in women with high-grade cervical intraepithelial neoplasia (CIN) and fully visible TZ. METHODS The current investigation was a retrospective study including women with fully visible TZ and CIN 3 cone histology between 2014 and 2019. The sample was divided into women with positive versus those with negative EM. Univariate and multivariate analyses were performed. Finally, receiver operating characteristic curve analysis was also used. RESULTS A total of 123 of 517 women (23.8%) showed positive EM at conization. Multivariate analysis found a positive association with type 2 TZ (odds ratio [OR], 2.17 [95% confidence interval (CI), 1.19-3.94]) and lesion extension ≥2 cervical quadrants (OR, 35.57 [95% CI, 17.96-70.45]). Cone depth was inversely related to positive EM (OR, 0.71 [95% CI, 0.63-0.80]). In women with type 2 TZ and lesion extension ≥2 cervical quadrants, the cutoff value was achieved at 8-mm cone depth (area under the curve, 0.79 [95% CI, 0.67-0.90]). CONCLUSION In women with high-grade CIN and fully visible TZ undergoing conization, the lesion extension and the TZ subtype (1 or 2) should be considered. A no less than 9-mm cone depth provided a fair predictive value in achieving free EM.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Barbara Gardella
- Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Antonio Liverani
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Roncella
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Arsenio Spinillo
- Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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Ding T, Li L, Duan R, Chen Y, Yang B, Xi M. Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia. Int J Gynaecol Obstet 2023; 160:538-547. [PMID: 35810389 PMCID: PMC10087663 DOI: 10.1002/ijgo.14340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/04/2022] [Accepted: 07/07/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the risk factors of recurrent high-grade cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after loop electrosurgical excision procedure (LEEP). METHODS This retrospective study included patients with histopathologically confirmed CIN2/3 who underwent LEEP in 2015-2020. Cox regression analysis was used to evaluate the risk factors of recurrence. RESULTS Recurrent CIN2+ was found in 268 patients after LEEP (268/4369, recurrence rate, 6.1%). High-risk (hr-) HPV infection (hazard ratio [HR] 12.09, 95% confidence interval [CI] 7.78-18.79), margin status (HR 6.48, 95% CI 4.75-8.84), baseline diagnosis (HR 1.45, 95% CI 1.08-1.95), smoking (HR 3.17, 95% CI 2.27-4.43), and immunosuppression (HR 1.96, 95% CI 1.33-2.91) were significant independent risk factors of recurrence. HPV16 (HR 3.61, 95% CI 2.43-5.37), HPV33 (HR 2.62, 95% CI 1.12-6.12), and HPV52 (HR 1.61, 95% CI 1.02-2.55) infection showed a higher risk of recurrence. High-risk HPV had the highest accuracy (sensitivity 88.5%; negative predictive values 98.7%) in predicting recurrence compared with liquid-based cytology test and margins. CONCLUSION Given that positive margins present a higher risk, wide excision may be required to avoid residual lesions. More attention should be paid to the correlation between recurrence and hr-HPV genotypes. After treatment for high-grade CIN, HPV-based testing is recommended at 6 months. Timely identification of high-risk factors enables risk stratification, and enables individual management or individual follow-up and recall strategies.
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Affiliation(s)
- Ting Ding
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Li
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ruiqi Duan
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yun Chen
- Department of Information Management, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bowen Yang
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Mingrong Xi
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
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11
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Davidesko S, Meirovitz M, Shaco-Levy R, Wainstock T, Baumfeld Y, Erenberg M, Sade S, Kessous R. Positive pathological margins after loop electrosurgical excision procedure - Management and outcome. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1031-1036. [PMID: 36737281 DOI: 10.1016/j.ejso.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/01/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Pathological involvement of cervical conization margins is a risk factor for recurrence, although management of these patients is controversial. We aimed to define risk factors for positive margins and compare recurrence following additional surgical intervention compared to conservative management. METHODS A retrospective study of all conizations at our center between 2010 and 2019. Univariate analysis identified characteristics associated with positive margins. Women were stratified by mode of management comparing three groups (surveillance, repeat conization or hysterectomy) then two groups (surveillance vs. additional surgery). Kaplan Meyer survival curves compared cumulative recurrence stratified by mode of management. Pathological results of subsequent surgical procedures were examined for residual disease. RESULTS Of 448 conizations performed, 131 (29.2%) had positive margins which were associated with menopause, high-grade cytology and endocervical gland involvement. Women who underwent surveillance (n = 45) were more likely to be nulliparous, with low-grade histology and less endocervical gland involvement. Women who underwent hysterectomy (n = 61) were more likely to be postmenopausal and parous. Recurrence did not differ significantly in the three-group (p = 0.073) or two-group model (6.4% vs. 7.1% p = 0.869). Kaplan Meyer survival curves depicting cumulative recurrence did not differ significantly in either model (log rank test p = 0.642 for the three-group model, and p = 0.868 for the two-group model). Residual disease was found in 51.6% of hysterectomy specimens and 52.6% of repeat conizations. CONCLUSION Surveillance is non-inferior to additional surgery in cases with positive conization margins and constitutes a valid option specifically for younger women at risk of future obstetric complications and those susceptible post-hysterectomy complications.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Mihai Meirovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruthy Shaco-Levy
- Department of Pathology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Miriam Erenberg
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shanny Sade
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roy Kessous
- Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Kwok ST, Chan KKL, Tse KY, Chu MMY, Lau LSK, Ngan HYS, Ngu SF. Outcome after loop electrosurgical excision procedure for cervical high-grade squamous intraepithelial lesion. Taiwan J Obstet Gynecol 2023; 62:45-49. [PMID: 36720549 DOI: 10.1016/j.tjog.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The dilemma in treating cervical high-grade squamous intraepithelial lesion (HSIL) is how to achieve complete excision to minimize the risk of cervical cancer while sparing the anatomy of the cervix and its ability to function during pregnancy. The optimal management for positive margins after excisional treatment is still controversial. This study was conducted to determine the clinical and histologic predictors of residual/recurrent HSIL and assess the outcome of women with positive margin. MATERIALS AND METHODS This retrospective cohort study included 386 women who had excisional treatment for HSIL during 1st January 2012 to 31st December 2015 in a university-affiliated hospital. RESULTS Overall, 212 (54.9%) women had negative margins and 155 (40.2%) had positive margins. The cumulative rate of residual/recurrent HSIL at 2 and 5 years was 15.7% and 16.8% respectively in positive margins and 1.8% and 5.0% respectively in negative margins (p < 0.001). Of women who had residual/recurrent HSIL, significantly more women had positive margins compared to negative margins (74.1% vs 25.9%, p = 0.001). Positive margin was significantly associated with higher rate of subsequent abnormal cervical smear (48.2% vs 28.9%, p < 0.001), requiring further colposcopy (32.1% vs 14.4%, p < 0.001) and further treatment for SIL (7.5% vs 4.8%, p < 0.001) compared to negative margin. CONCLUSION Most women (85%) with positive margin went without residual/recurrent HSIL, of which the option of close surveillance with cytology is reasonable. Repeat excision may be considered in selected women with positive margin, endocervical glandular involvement and those who are older or unable to comply with follow-up.
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Affiliation(s)
- Shuk Tak Kwok
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Karen K L Chan
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ka Yu Tse
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Mandy M Y Chu
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Lesley S K Lau
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hextan Y S Ngan
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Siew-Fei Ngu
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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13
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Bruhn LV, Hyldig N, Schledermann D. HPV Test as Test of Cure After Conization for CIN2+: A Nationwide Register-Based Cohort Study. J Low Genit Tract Dis 2022; 26:287-292. [PMID: 36126201 PMCID: PMC9508974 DOI: 10.1097/lgt.0000000000000693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess if cytology can be omitted in the follow-up after treatment for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and if human papillomavirus (HPV) test can be used alone as test of cure (TOC) after stratifying for resection margins. MATERIAL AND METHODS In this retrospective register-based study, women who had a conization performed in Denmark between January 1 and December 31, 2013, were included. Histology, cytology, and HPV test results were obtained from The Danish Pathology Data Bank for a 3-year follow-up. RESULTS A total of 5,174 women were included, of whom 6.1% (318/5,174) had histological residual/recurrent disease in the follow-up period. In the group with free margins, 2.6% (73/2,780) had residual/recurrent disease in contrast to 10.2% (245/2,394) in the group with involved margins. In the group with free resection margins and negative HPV test results, residual/recurrent disease was found in 0.5% (13/2,780) compared with 0.3% (9/2,780) in the group with negative HPV test results and normal cytology at 6 months' follow-up. Based on margin status and HPV test result as follow-up, the sensitivity, specificity, and positive and negative predictive values were 95.9%, 43.2%, 10.0%, and 99.4% respectively, and for combined testing (margin status, HPV, and cytology), 97.2%, 41.2%, 9.8%, and 99.6%, respectively. CONCLUSIONS Using the HPV test at the first post-treatment control as TOC for cervical intraepithelial neoplasia grade 2 or worse after stratifying for resection margins in cone resections yields an equally high sensitivity and negative predictive value as cotesting with cytology. We suggest that women with free resection margins return to the routine screening program after negative HPV test result as TOC at 6 months.
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Affiliation(s)
- Lærke Valsøe Bruhn
- Department of Pathology, Southern Jutland Hospital, Denmark
- Department of Pathology, Odense University Hospital, Denmark
- OPEN Open Patient Data Explorative Network, Odense University Hospital, Denmark
| | - Nana Hyldig
- Department of Hematology, Odense University Hospital, Denmark
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Practical Model for Residual/Recurrent Cervical Intraepithelial Lesions in Patients with Negative Margins after Cold-Knife Conization. J Clin Med 2022; 11:jcm11195634. [PMID: 36233503 PMCID: PMC9573483 DOI: 10.3390/jcm11195634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/04/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: This study aimed to identify reliable risk factors for residual/recurrent cervical intraepithelial lesions in patients with negative margins after cold-knife conization. Methods: A total of 2352 women with HSILs (high-grade squamous intraepithelial lesions) with negative margins who underwent cold-knife conization between January 2014 and December 2020 were included; in total, 1411 women were assigned to the development cohort, and 941 women were assigned to the validation cohort. Multivariate logistic regression was used to build four predictive models based on the different combinations of follow-up data (Model A: preoperative factors; Model B: first-follow-up data; Model C: second-follow-up data; Model D: data from both follow-ups). The accuracy, sensitivity, specificity, false-positive rate (FPR), false-negative rate (FNR), and area under the receiver operating characteristic curve (AUC) were evaluated on the validation cohort. The predictive power of risk factors was further validated using six machine learning algorithms. Results: Model D demonstrated the highest AUC of 0.91 (95% CI, 0.87 to 0.96) in the validation cohort, whereas Models A, B, and C achieved AUCs of 0.69 (95% CI, 0.59 to 0.78), 0.88 (95% CI, 0.80 to 0.95), and 0.89 (95% CI, 0.81 to 0.97) respectively. The six machine learning methods achieved consistent results. Kaplan-Meier (KM) survival curves demonstrated that our models could effectively stratify patients with all models (p < 0.05 for all models). Conclusion: Our model, which is based on preoperative and follow-up factors, can serve as a complementary screening procedure for the early detection or prediction of recurrence after cold-knife conization in HSIL patients.
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15
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Michalczyk K, Misiek M, Chudecka-Głaz A. Can Adjuvant HPV Vaccination Be Helpful in the Prevention of Persistent/Recurrent Cervical Dysplasia after Surgical Treatment?—A Literature Review. Cancers (Basel) 2022; 14:cancers14184352. [PMID: 36139514 PMCID: PMC9496656 DOI: 10.3390/cancers14184352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Primary prophylactic, early detection and the treatment of precancerous lesions are the main goals of cervical cancer screening. Despite effective surgical treatment methods, using loop electrosurgical excision procedures and conization, the overall risk of the recurrence of HSIL lesions remains at approximately 6.6%. There is increasing evidence of the potential role of HPV vaccines in the adjuvant setting and their impact on the reduction of disease recurrence. This review aims to analyze the up-to-date research concerning the use and efficacy of secondary human papilloma virus (HPV) vaccination as an adjuvant method to surgical treatment in patients diagnosed with cervical HSILs. Abstract Cervical cancer formation is preceded by precursor lesions, including low-grade squamous intraepithelial lesions (LSILs) and high-grade squamous intraepithelial lesions (HSILs), which are usually diagnosed in women of reproductive age. Despite the recent advanced diagnostic and treatment methods, including colposcopy, the loop electrosurgical excision procedure (LEEP), and surgical conization, the recurrence or residual disease affects as many as 6.6% of patients. The lesions are often associated with human papilloma virus (HPV) infection. As HPV persistence is the leading and only modifiable factor affecting the risk of progression of CIN lesions into high-grade cervical dysplasia and cancer, it has been proposed to conduct adjuvant vaccination in patients treated for high-grade cervical dysplasia. To date, no vaccine has been approved for therapeutic use in patients diagnosed with HSILs; however, attempts have been made to determine the use of HPV prophylactic vaccination to reduce recurrent HSILs and prevent cervical cancer. The aim of this review was to analyze the up-to-date literature concerning the possible use of secondary human papilloma virus (HPV) vaccination as an adjuvant method to surgical treatment in patients diagnosed with cervical HSILs. Adjuvant HPV vaccination after surgical treatment may reduce the risk of recurrent cervical dysplasia.
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Affiliation(s)
- Kaja Michalczyk
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence:
| | - Marcin Misiek
- Holy Cross Cancer Center, Clinical Gynecology, 25-743 Kielce, Poland
| | - Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-204 Szczecin, Poland
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Belkić K, Andersson S, Alder S, Mints M, Megyessi D. Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow‑up. Oncol Lett 2022; 24:357. [PMID: 36168314 PMCID: PMC9478621 DOI: 10.3892/ol.2022.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of adenocarcinoma-in-situ (AIS) of the uterine cervix is rising, with invasive adenocarcinoma becoming increasingly common relative to squamous cell carcinoma. The present study reviewed a cohort of 84 patients first-time treated by conization for histologically-confirmed AIS from January 2001 to January 2017, to identify risk factors associated with recurrent/persistent AIS as well as progression to invasive cervical cancer. Nearly 80% of the patients were age 40 or younger at conization. Endocervical and ectocervical margins were deemed clear in 42 of the patients. All but two patients had ≥1 follow-up, with post-conization high-risk human papilloma virus (HPV) results documented in 52 patients. Altogether, 12 histopathologically-confirmed recurrences (14.3%) were detected; two of these patients had microinvasive or invasive carcinoma. In three other patients cytology showed AIS, but without recorded histopathology. Eight patients underwent hysterectomy for incomplete resection very soon after primary conization; they were not included in bivariate or multivariate analyses. Having ≥1 post-follow-up positive HPV finding yielded the highest sensitivity for histologically-confirmed recurrence: 87.5 [95% confidence interval (CI) 47.4-99.7]. Current or historical smoking status provided highest specificity: 94.4 (95% CI 72.7-99.9) and overall accuracy: 88.0 (95% CI 68.8-97.5) for histologically-confirmed recurrence. With multiple logistic regression (MLR), adjusting for age at conization and abnormal follow-up cytology, positive HPV18 was the strongest predictor of histologically-confirmed recurrence (P<0.005). Having ≥2 positive HPV results also predicted recurrence (P<0.02). Any unclear margin yielded an odds ratio 7.21 (95% CI 1.34-38.7) for histologically-confirmed recurrence adjusting for age, but became non-significant when including abnormal cytology in the MLR model. The strong predictive value of HPV, particularly HPV18 and persistent HPV positivity vis-à-vis detected recurrence indicated that regular HPV testing for patients treated for AIS is imperative. In conclusion, furthering a participatory approach, including attention to smoking with encouragement to attend needed long-term follow-up, can better protect these patients at high risk for cervical cancer.
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Affiliation(s)
- Karen Belkić
- Department of Oncology‑Pathology, Karolinska Institute, SE‑17176 Stockholm, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics‑Gynecology Division, Karolinska Institute, Stockholm, SE‑17176 Stockholm, Sweden
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Wang Y, Wang J, Mei H. Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing. Emerg Med Int 2022; 2022:9621893. [PMID: 35941961 PMCID: PMC9356899 DOI: 10.1155/2022/9621893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the diagnosis of cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC) by cervical biopsy under colposcopy and analyze the factors influencing the detection. Methods The clinical data of 134 CIN confirmed by colposcopy biopsy in our hospital from June 2018 to October 2019 and subsequent LEEP treatment were analyzed retrospectively. All patients were diagnosed pathologically after the operation. The diagnosis of CIN by cervical biopsy under colposcopy was observed. The influencing factors of CIN and ICC detected by colposcopy biopsy were analyzed by the pathological results of loop electrosurgical excision procedure (LEEP) as the gold standard. Results After LEEP, the number of the no intraepithelial or malignant lesions (NILM) or ICC were higher than that of colposcopy biopsy, and CIN-III was lower than that of colposcopy biopsy, the differences were all statistically significant (P < 0.05). Among the 134 patients, the coincidence rate between colposcopy biopsy and LEEP examination results was 79.10% (106/134), and postoperative pathological findings showed that there were 13 cases (9.70%) with the pathological upgrade and 19 cases (14.18%) with pathological decrease. Multivariate logistic analysis showed that the image quality of colposcopy image, atypical blood vessels, biopsy sampling method, and visible lesion area of the cervix were the independent influencing factors for the detection of CIN and ICC by colposcopy biopsy (P < 0.05). Conclusion CIN and ICC can be diagnosed by colposcopy cervical biopsy and postoperative histopathology. However, there are still some missed and misdiagnosed cervical biopsies under colposcopy, and the combined detection of the two can further ensure the diagnosis rate. The clinical registration number is E2018091.
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Affiliation(s)
- Ying Wang
- Medical Department of Wuhan Wudong Hospital, Wuhan 430084, Hubei, China
| | - Jing Wang
- Hubei Materal and Child Health Hospital, Wuhan 430064, Hubei, China
| | - Hua Mei
- Hospital Infection Branch, Wuhan Wudong Hospital Public Health, Wuhan 430084, Hubei, China
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Kim NR, Baek ZH, Lee AJ, Yang EJ, Ouh YT, Kim MK, Shim SH, Lee SJ, Kim TJ, So KA. Clinical Outcomes Associated with Endocervical Glandular Involvement in Patients with Cervical Intraepithelial Neoplasia III. J Clin Med 2022; 11:jcm11112996. [PMID: 35683385 PMCID: PMC9181062 DOI: 10.3390/jcm11112996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to determine whether endocervical glandular involvement (GI) affects the clinical prognosis of patients with cervical intraepithelial neoplasia (CIN) III who underwent the loop electrosurgical excision procedure (LEEP). This retrospective study included 250 patients who underwent LEEP for the treatment of CIN III between August 2005 and May 2020. The medical records of 234 patients were analyzed; 137 (58.5%) patients were GI negative, and 97 (41.5%) were GI positive. Margin involvement of the LEEP specimen was found in 59 (45.4%) patients in the GI-negative group and 54 (58.7%) patients in the GI-positive group (p = 0.051). The additional surgical procedures (repeat conization or hysterectomy) were significantly more performed in GI-positive patients than in GI-negative patients (40.9% vs. 23.1%, p = 0.004). When comparing the LEEP specimens of GI-1 (GI-positive confirmed via cervical biopsy before conization) and GI-2 (GI-positive confirmed via conization), we found that the mean depth was significantly greater in the GI-1 group (10.9 mm) than in the GI-2 group (7.6 mm) (p = 0.024). Surgical margin involvement was more frequently observed in the GI-2 group than in the GI-1 group (p = 0.030). There was no significant difference in the recurrence rates of CIN between the GI-negative and GI-positive groups (p = 0.641). In conclusion, despite no significant differences in residual disease and CIN recurrence between the GI-negative and GI-positive groups, additional surgical treatments were more frequently performed in GI-positive patients. Repeat surgery based on GI positivity should be carefully considered to avoid overtreatment and surgical complications.
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Affiliation(s)
- Nae Ry Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - Zee Hae Baek
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - A Jin Lee
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - Eun Jung Yang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kangwon National University, Kangwon 24341, Korea;
| | - Mi Kyung Kim
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul 07985, Korea;
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - Sun Joo Lee
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
| | - Kyeong A So
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; (N.R.K.); (Z.H.B.); (A.J.L.); (E.J.Y.); (S.-H.S.); (S.J.L.); (T.J.K.)
- Correspondence: ; Tel.: +82-2-2030-7524
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Hendriks N, Koeneman MM, van de Sande AJ, Penders CG, Piek JM, Kooreman LF, van Kuijk SM, Hoosemans L, Sep SJ, de Vos Van Steenwijk PJ, van Beekhuizen HJ, Slangen BF, Nijman HW, Kruitwagen RF, Kruse AJ. Topical Imiquimod Treatment of High-grade Cervical Intraepithelial Neoplasia (TOPIC-3): A Nonrandomized Multicenter Study. J Immunother 2022; 45:180-186. [PMID: 35180719 PMCID: PMC8906243 DOI: 10.1097/cji.0000000000000414] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
Topical imiquimod could be an alternative, noninvasive, treatment modality for high-grade cervical intraepithelial neoplasia (CIN). However, evidence is limited, and there are no studies that compared treatment effectiveness and side effects of topical imiquimod cream to standard large loop excision of the transformation zone (LLETZ) treatment. A multi-center, nonrandomized controlled trial was performed among women with a histologic diagnosis of CIN 2/3. Women were treated with either vaginal imiquimod (6.25 mg 3 times weekly for 8 to 16 wk) or LLETZ according to their own preference. Successful treatment was defined as the absence of high-grade dysplasia at the first follow-up interval after treatment (at 20 wk for the imiquimod group and at 26 wk for the LLETZ group). Secondary outcome measures were high-risk human papillomavirus (hrHPV) clearance, side effects, and predictive factors for successful imiquimod treatment. Imiquimod treatment was successful in 60% of women who completed imiquimod treatment and 95% of women treated with LLETZ. hrHPV clearance occurred in 69% and 67% in the imiquimod group and LLETZ group, respectively. This study provides further evidence on topical imiquimod cream as a feasible and safe treatment modality for high-grade CIN. Although the effectiveness is considerably lower than LLETZ treatment, imiquimod treatment could prevent initial surgical treatment in over 40% of women and should be offered to a selected population of women who wish to avoid (repeated) surgical treatment of high-grade CIN.
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Affiliation(s)
- Natasja Hendriks
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Margot M. Koeneman
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | | | - Charlotte G.J. Penders
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Jurgen M.J. Piek
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven
| | | | - Sander M.J. van Kuijk
- Department of Methodology and Statistics
- CAPHRI—School for Care and Public health Research Institute, Maastricht University, Maastricht
| | | | - Simone J.S. Sep
- Internal Medicine, Maastricht University Medical Center
- CAPHRI—School for Care and Public health Research Institute, Maastricht University, Maastricht
| | | | | | - Brigitte F.M. Slangen
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Hans W. Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen
| | - Roy F.P.M. Kruitwagen
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
| | - Arnold-Jan Kruse
- Departments of Obstetrics and Gynecology
- GROW—School for Oncology and Developmental Biology
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
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Zhu M, Yu M, Chen Z, Zhao W. Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy. Front Med (Lausanne) 2022; 9:807849. [PMID: 35295609 PMCID: PMC8918980 DOI: 10.3389/fmed.2022.807849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Currently, the commonly used surgical methods for cervical lesions include loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). However, the positive rate of surgical margins after LEEP is relatively high, which leads to disease recurrence and places further demand on clinical treatment. This study investigated factors related to positive margins after LEEP and established a scoring system to enhance preoperative risk assessment and surgical selection. Materials and Methods A retrospective analysis of the clinical data of 411 patients undergoing LEEP surgery for cervical lesions in the First Affiliated Hospital of University of Science and Technology of China (USTC), from January 2016 to March 2021, was performed. Cases were divided into a negative margin group (349 cases) and a positive margin group according to postoperative pathology. In the positive group (62 cases), single-factor and multi-factor analyses screened influencing factors; a logistic and additive scoring system was established; furthermore, a ROC curve was used to evaluate scoring effectiveness. Results The positive rate of resection margins after LEEP was 15.1%. Univariate analysis indicated a relationship to patient age, menopause, preoperative ThinPrep Cytology Test (TCT) results, lesion quadrant number under colposcopy, cervical biopsy, and the result of endocervical curettage (ECC). Multivariate analysis showed that age >35 y, menopause, preoperative TCT being high-grade squamous intraepithelial lesion (HSIL), four quadrants being involved under colposcopy, and ECC being HSIL were all independent influencing factors of positive margins after LEEP (P < 0.05). These were included with the above factors to establish a logistic and additive scoring system. When the logistic score was 17, the sensitivity and specificity of predicting positive margins after LEEP were 80.6 and 61.6%, respectively. When the additive score was 6, the sensitivity and specificity were 74.2 and 66.2%, respectively. Both scoring systems had good predictability (area under the curve AUC >0.75). Conclusions This study quantified factors influencing positive margins after LEEP and established a scoring system for evaluating patients before surgery to provide a basis for individualized treatment and selection of surgical methods.
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Affiliation(s)
- Meiling Zhu
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Mingyue Yu
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Zhengzheng Chen
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
- *Correspondence: Zhengzheng Chen
| | - Weidong Zhao
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
- Weidong Zhao
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Mirandez CC, Yoneda JY, Gertrudes LN, Carvalho CF, Derchain S, Teixeira JC, Vale DB. The value of the endocervical margin status in LEEP: analysis of 610 cases. Arch Gynecol Obstet 2022; 306:851-856. [DOI: 10.1007/s00404-022-06464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022]
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22
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Laser conization for cervical intraepithelial neoplasia: effectiveness and obstetric outcomes. J Gynecol Obstet Hum Reprod 2022; 51:102341. [PMID: 35181542 DOI: 10.1016/j.jogoh.2022.102341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the effectiveness and obstetric outcomes after laser conization for cervical intraepithelial neoplasia METHODS: This retrospective study included 757 patients who underwent laser conization between 2014 and 2020. Patients with a diagnosis of invasive lesions or adenocarcinoma in situ were excluded. Histological data from the conization specimen, pre and postoperative histological and virological data (Human PapillomaVirus (HPV) test) and obstetric outcomes were collected from the medical record. The primary endpoint was the negative surgical margin rates after laser conization. The secondary endpoint were the size of the operative specimen, the postoperative virological test results (3 to 6 months after surgery), factors associated with negative or positive margin and postoperative obstetric outcomes (prematurity). Patient characteristics and outcomes were compared using Student's t test, χ² test, or Fisher exact test. Values of p ≤0.05 were considered significant. RESULTS This study included 757 patients. Negative surgical margins were obtained in 76.1% of the cases and were associated with more negative HPV tests at 6 months (64.9% vs. 52.5%, p=0.006) and fewer repeat surgeries (0.2% vs. 2.2%, p=0.013) than for patients with positive margins. Among the patients under 43 years at the time of conization, 71 achieved a pregnancy with a term >22 weeks, and of these 66 (93%) delivered at term (≥37 weeks). CONCLUSION Laser conization appears to be an effective technique for the management of cervical intraepithelial neoplasia both in terms of the quality of the resection margins and the obstetric prognosis.
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Kim M, Choi MC, Lee C, Na YJ, Kim SJ. Long-term outcomes of photodynamic therapy for a positive resection margin after conization for cervical intraepithelial neoplasia grade 3. Photodiagnosis Photodyn Ther 2021; 37:102639. [PMID: 34823035 DOI: 10.1016/j.pdpdt.2021.102639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Positive resection margins after conization or loop electrosurgical excision procedure (conization/LEEP) are associated with increased risks of recurrence or residual cervical intraepithelial neoplasia (CIN). Herein, we investigated the long-term outcomes of photodynamic therapy (PDT) for incomplete excision of CIN3. METHODS We retrospectively reviewed the medical charts of 73 patients treated with PDT between 2000 and 2011. Patients who underwent conization/LEEP before PDT within 6 months were included. The primary outcomes were the complete response (CR) rate after 1 year and human papillomavirus (HPV) eradication rate at 6 months after PDT. RESULTS A total of 34 patients with positive resection margins were finally enrolled. The median patient age was 33 years. Carcinoma in situ was diagnosed in 25 patients and CIN3 in 7 patients. The CR rate was 97.1% after 1 year. Except for one case of a persistent disease, there was no recurrence or newly developed disease during the median follow-up of 84 months (range, 12-224 months). The HPV eradication rate of PDT following conization/LEEP after 6 months was 96.9% (31/32). Photosensitivity was identified in five patients and cervical stenosis in one patient. CONCLUSIONS In conclusion, PDT could be an effective therapeutic option for patients with a positive resection margin after conization/LEEP for CIN3. It could reduce the residual or recurrence rate of CIN lesions with tolerable adverse events.
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Affiliation(s)
- Migang Kim
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do 13496, Korea
| | - Min Chul Choi
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Chan Lee
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Young Jeong Na
- Gynecologic Oncology Center, CHA Ilsan Medical Center, CHA University, Goyang-si, Gyeonggi-do 10414, Korea
| | - Seung Jo Kim
- Sangkyungwon Intermed Cancer Hospital, Yeoju-si, Gyeonggi-do 12616, Korea
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Andersson S, Megyessi D, Belkić K, Alder S, Östensson E, Mints M. Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment. Oncol Lett 2021; 22:684. [PMID: 34434283 PMCID: PMC8335741 DOI: 10.3892/ol.2021.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4–6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3–9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0–14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0–16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4–11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.
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Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.,Institute for Health Promotion & Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebrö, Sweden
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Escamilla Galindo EP, Medina Ramos NF, Santana Mateo YL, Armas Roca M, Molero Sala L, León Arencibia L, Arencibia Sánchez O, Martín Martínez AI. Post-Conization FIGO stage IA1 squamous cell cervical carcinoma; is hysterectomy necessary? Eur J Obstet Gynecol Reprod Biol 2021; 264:368-373. [PMID: 34399105 DOI: 10.1016/j.ejogrb.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare and evaluate the results and suitability of two different approaches to the treatment of post-conization International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 cervical carcinoma: a more radical approach, directly scheduling a second surgery versus a more conservative one, which consists of performing a cotest (PAP plus HPV-test) in a follow-up visit and deciding whether to apply a second surgery on the basis of the results. STUDY DESIGN Retrospective descriptive study including 144 cases of stage IA1 cervical carcinoma diagnosed after a loop electrosurgical excisional procedure (conization), between 1987 and 2019 in the Mother-and-Child University Hospital of Gran Canaria (Spain). Selected patients were split into two groups for analysis: patients directly undergoing a second surgical intervention (hysterectomy or re-conization) after diagnosis and patients who were followed-up before making a decision whether to schedule a second surgery or continue to follow-up. RESULTS 75% of women directly receiving a second surgical intervention (no post-conization follow-up) underwent hysterectomy, while 25% underwent re-conization. Histological outcomes from hysterectomized patients showed 65% negative results for intraepithelial lesions, 9% low-grade squamous intraepithelial lesions (LSIL), 16% high-grade squamous intraepithelial lesions (HSIL) and only 10.5% confirmed invasive lesions: hysterectomy complication rate was 7%. Histological studies from women subjected to re-conization showed 32% negative results, 37% LSIL, 5% HSIL and 26% malignancy. In the group of patients who were followed-up after diagnosis, 8.8% needed a second intervention; none of them showed negative histological results, while 100% hysterectomized and 25% patients with re-conization showed HSIL. No unnecessary hysterectomy procedures were conducted in this group. HPV-16 was the most common genotype in both groups. CONCLUSION Conization proved to be a suitable alternative to hysterectomy as a treatment for post-conization stage IA1 cervical cancer. Our results showed that 65% hysterectomy procedures conducted without previously monitoring for residual disease corresponded to negative results and were therefore, unnecessary. We conclude that confirmation of the presence of residual disease by using cotest is essential to make a decision on further treatment and that a conservative management is often possible and, in our opinion, preferable.
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Affiliation(s)
- Esther Patricia Escamilla Galindo
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Norberto Fidel Medina Ramos
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Yaned Lourdes Santana Mateo
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Marta Armas Roca
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Laura Molero Sala
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Laureano León Arencibia
- Department of Pathology, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Octavio Arencibia Sánchez
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Alicia Inmaculada Martín Martínez
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
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26
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Ge Y, Liu Y, Cheng Y, Liu Y. Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization. Medicine (Baltimore) 2021; 100:e26359. [PMID: 34232170 PMCID: PMC8270570 DOI: 10.1097/md.0000000000026359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization.Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data.After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases (P < .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317-3.492, P < .05), history of preterm birth (HR = 4.515, 95% CI: 1.598-12.754, P < .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952-6.462, P < .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth >0.5 cm was a protective factor for postoperative recurrence.For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (>0.5 cm) with lower risk of recurrence.
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Affiliation(s)
- Yan Ge
- Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China
| | - Yongli Liu
- Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China
| | - Yun Cheng
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yanbo Liu
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
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Abdulaziz AM, You X, Liu L, Sun Y, Zhang J, Sun S, Li X, Sun W, Dong Y, Liu H, Zhang Y. Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization: A retrospective study. Medicine (Baltimore) 2021; 100:e26030. [PMID: 34011112 PMCID: PMC8137043 DOI: 10.1097/md.0000000000026030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
To explore the optimal way to manage patients with high-grade squamous intraepithelial lesion (HSIL) and positive margin by identifying the risk factors for its recurrence and residue.A retrospective study was conducted on 267 cases of a pathologically confirmed HSIL with positive margin following conization by loop electrosurgical excisional procedure (LEEP) between January 2010 and December 2015. One hundred two cases were selected for regular follow-up every 6 months, and 165 cases were selected for a second surgery (repeat cervical conization or hysterectomy) within 3 months of initial LEEP. We analyzed the association between recurrent or residual diseases and these factors: age, menopausal status, ThinPrep cytologic test (TCT) results, high-risk human papillomavirus (HR-HPV) infection, pathological grades of the margin, number of involved margins, and glandular involvement.The recurrence rate among 102 cases who underwent follow-up was 17.6% (18/102). The factors: atypical squamous cells of undetermined significance cannot exclude HSIL (ASC-H) or higher lesions in the pre-LEEP TCT (P = .038), persistent HR-HPV infection at the 6th month post-LEEP (P = .03), HSIL-positive margin (P = .003), and multifocal-involved margin (P = .002) were significantly associated with recurrent disease, while age, menopause, and pre-LEEP HR-HPV infection were not associated with recurrent disease (P > .05). The residual rate among 165 patients who underwent a second surgery was 45.5% (75/165), of which 15 cases were residual cervical cancer. The factors: menopause (P = .02), ≥ASC-H in pre-LEEP TCT (P = .04), pre-LEEP HR-HPV infection (P = .04), ≥HSIL-positive margin (P < .001), and multifocal-involved margin (P < .001) significantly increased the risk of residual disease. No correlation existed between residual disease and age or glandular involvement (P > .05).For patients with a positive margin after LEEP, regular follow-up or second surgery should be selected according to fertility requirement and pathological characteristics of the positive margin, as well as TCT and HR-HPV infection condition.
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Ikeda M, Mikami M, Yasaka M, Enomoto T, Kobayashi Y, Nagase S, Yokoyama M, Katabuchi H. Association of menopause, aging and treatment procedures with positive margins after therapeutic cervical conization for CIN 3: a retrospective study of 8,856 patients by the Japan Society of Obstetrics and Gynecology. J Gynecol Oncol 2021; 32:e68. [PMID: 34132067 PMCID: PMC8362807 DOI: 10.3802/jgo.2021.32.e68] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/17/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The Japan Society of Obstetrics and Gynecology conducted a retrospective multi-institutional survey of patients who underwent cervical conization in Japan. This study aimed to determine the predictive factors for positive surgical margins in cervical intraepithelial neoplasia grade 3 (CIN 3) patients after therapeutic cervical conization and those for positive margins in patients who did not experience recurrence and did not undergo additional treatment. Methods In 2009 and 2013, 14,832 patients underwent cervical conization at 205 institutions in Japan. Of these, 8856 patients who underwent therapeutic conization fulfilled the inclusion criteria. Their histologic findings and clinical outcomes were evaluated based on standard statistical procedures and clinical and demographic characteristics. Results Negative and positive margins were observed in 7,585 and 1,271 (14.4%) patients, respectively. The predictors of positive margins were menopausal status (p<0.001), loop electrosurgical excision procedure (p<0.001), and Shimodaira-Taniguchi (S-T) conization (p<0.001). Of 1,271 patients with positive margins, 1,060 underwent no additional treatment; among those 1,060 patients, 129 (12.2%) experienced recurrence. The predictors of positive margins in patients who did not undergo additional treatment and did not experience recurrence were age, parity, gravidity, S-T conization, and laser scalpel conization. Conclusion Menopausal status and treatment procedures were associated with positive margins after therapeutic conization of CIN 3. It is important to understand the characteristics of treatment procedures and select an appropriate procedure for each case. For elderly or menopausal patients with positive margins, immediate additional treatment is recommended.
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Affiliation(s)
- Masae Ikeda
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Miwa Yasaka
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoichi Kobayashi
- Department of Obstetrics and Gynecology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Saga University Faculty of Medicine, Saga, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
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Kamio M, Yanazume S, Togami S, Kobayashi H. Association Between Positive Human Papillomavirus Status After Conization and Disease Recurrence in Patients with Cervical Intraepithelial Neoplasia Grade 3. J Obstet Gynaecol India 2020; 71:66-71. [PMID: 33814801 DOI: 10.1007/s13224-020-01368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to examine the associations of cone margin and human papillomavirus (HPV) status after conization with cytological abnormalities and disease recurrence in patients with cervical intraepithelial neoplasia grade 3 (CIN3). Methods This is a retrospective study of 366 women with CIN3 who underwent conization at Kagoshima University Hospital between 2004 and 2017. Conization was performed using an ultrasonic scalpel. The polymerase chain reaction for detecting HPV genotypes was performed using fresh cervical cell samples. We examined the associations of margin status and HPV status after conization with cytological abnormalities and recurrence. Results Among 224 women with CIN3, 193 (86.2%) underwent HPV genotype testing before conization. The HPV-positive rate was 84.9%. The most common HPV genotypes before conization were HPV 16, 31, 58, 52, 18, 35, and 33. In 191 patients, the uterus was preserved after conization. Sixteen patients had pathologically positive margins, 165 had negative margins, and 10 had unclear margins. There was no significant difference in abnormal cytology and recurrence rate after conization between the three groups. Five patients with positive margins and abnormal cytology during follow-ups were HPV16- or HPV58-positive in the preoperative HPV testing. Of the 191 women, 91 (47.6%) underwent pre- and postoperative HPV genotype testing, among whom 14 (15.4%) were HPV-positive after conization. No significant difference in abnormal cytology based on HPV status after conization was found. The recurrence rate tended to be higher in HPV-positive patients than in HPV-negative patients after conization (21.4% vs. 1.3%, p < 0.05). Three patients with HPV positivity after conization and recurrence during follow-up were HPV16- or HPV58-positive. Conclusions HPV positivity after conization for CIN3 was associated with a high recurrence rate, especially in HPV16- and HPV58-positive patients. HPV58 has not received much attention thus far, but abnormalities in cytology and recurrence may be as likely as those associated with HPV16. Thus, a careful follow-up in such patients is recommended.
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Affiliation(s)
- Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
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Role of Colposcopy after Treatment for Cervical Intraepithelial Neoplasia. Cancers (Basel) 2020; 12:cancers12061683. [PMID: 32599929 PMCID: PMC7352967 DOI: 10.3390/cancers12061683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 12/31/2022] Open
Abstract
Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN.
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Cao D, Shen K, Chen Y, Xu Y, Wu D. Value of endocervical curettage in follow-up for patients with cervical intraepithelial neoplasia stage 2+ after loop electrosurgical excision. Gynecol Oncol 2020; 158:584-589. [PMID: 32586604 DOI: 10.1016/j.ygyno.2020.06.490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the value of endocervical curettage (ECC) during follow-up for patients with cervical intraepithelial neoplasia (CIN2+) after loop electrosurgical excision procedures (LEEP) and to explore risk factors for positive ECC during this evaluation. METHODS There were 383 CIN2+ patients in the one-step method group who underwent LEEP and were prospectively followed up using ECC as a routine strategy, with colposcopy and liquid-based cytology (LCT) + human papilloma virus (HPV) co-testing performed. The finding were then compared with those from 1041 patients in the retrospective database who underwent colposcopy unless LCT and/or HPV screening was abnormal, and ECC was performed depending on colposcopy images (two-step method group). The two groups were matched using propensity score matching analysis for further statistical comparisons. RESULTS In total, 383 pairs of patients from both groups were matched. The persistent/recurrent CIN2+ cases were 20 and 21, respectively (P > .05). However, 47 persistent/recurrent CIN1 cases were detected in the one-step method group; this number was significantly higher than that detected in the two-step method group (P < .05). High-risk factors for positive ECC during follow-up included positive ECC before treatment (odds ratio [OR]: 1.670), involved margins (OR: 1.239), and HPV infection and abnormal LCT during follow-up (ORs: 3.130 and 2.637). CONCLUSIONS ECC can detect early recurrent lesions after LEEP in patients with CIN2+ and can offset the limitation of colposcopy and co-testing resulting from LEEP. For patients with positive ECC before LEEP, involved margins, HPV infection, and abnormal LCT after treatment, ECC should be included in the follow-up strategy.
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Affiliation(s)
- Dan Cao
- The Center for Cervical disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Kaiying Shen
- Department of Pediatric Orthopedics, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- The Center for Cervical disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Ying Xu
- The Center for Cervical disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China
| | - Dan Wu
- The Center for Cervical disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China.
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What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status? Eur J Obstet Gynecol Reprod Biol 2019; 244:180-184. [PMID: 31812841 DOI: 10.1016/j.ejogrb.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies have shown associations between independent pre-conization variables (e.g. smoking, age, cytological grade, menopause) and positive or negative cone margins. However, it is not clear if these pre-surgical variables add predictive value to cone dimensions in the prediction of cone margin status. This study aimed to compare different models predicting positive ecto- or endocervical margins to assess whether pre-conization variables provide significant added value compared with cone dimensions alone. STUDY DESIGN One hundred and sixty-one consecutive women with high-grade cervical intra-epithelial neoplasia on cone specimens were analysed retrospectively. The sample was divided into women with positive ecto- or endocervical cone margins and women with negative ecto- or endocervical cone margins. Pre-conization clinical features, cone volume and cone length were included among the study variables. Multivariate stepwise regression analysis was used to create different models predicting incomplete cervical excision. The added value of pre-conization predictors was measured with receiver operating characteristic (ROC) curve comparisons. RESULTS Fifty-seven (35.4 %) women had incomplete cervical excision. Multivariate analysis showed that a positive ectocervical margin was significantly associated with low-grade cervical cytology [odds ratio (OR) = 0.25, 95 % confidence interval (CI) 0.09-0.70] and cone length (OR = 0.69, 95 % CI 0.58-0.82, criterion <9 mm). The area under the curve (AUC) of the combined model for prediction of a positive ectocervical margin was 0.78 (95 % CI 0.70-0.84, p < 0.001). A positive endocervical margin was associated with cone length (OR=0.78, 95 % CI 0.65-0.93, criterion <9 mm) and age (OR=1.07, 95 % CI 1.02-1.11, criterion ≥45 years). The AUC of the combined model for prediction of positive endocervical margin was 0.75 (95 % CI 0.66-0.82, p < 0.001). Comparison of ROC curves showed that the addition of pre-conization variables to cone length did not yield significant predictive results for either ecto- or endocervical cone margins (p = 0.228 and 0.349, respectively). CONCLUSIONS The addition of pre-conization clinical variables to cone dimensions did not improve the prediction of cone margin status significantly in the study cohort. Among cone dimensions, cone length was the best predictor of come margin status.
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