Lea Jayanthi S, Shin Christine H, Sheets Ellen E, Coleman Robert L, Gehrig Paola A, Duska Linda R, Miller David S, Schorge John O
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA.
Gynecol Oncol. 2002 Oct;87(1):129-32. doi: 10.1006/gyno.2002.6791.
To determine if performing an endocervical curettage (ECC) at the time of conization is a useful diagnostic tool for predicting residual cervical adenocarcinoma in situ (AIS) among women who might wish to preserve their fertility.
All patients diagnosed with AIS from 1995 to 2000 at four institutions were identified. Data were retrospectively extracted from clinical records. Women included in the statistical analysis were (1) younger than 40 years, (2) had an ECC performed at the time of the initial cone biopsy, (3) had a clearly demarcated surgical margin pathologically, and (4) underwent a second surgical procedure.
Twenty-nine (24%) of 123 AIS patients met criteria for inclusion. The median age was 33 years (range, 17 to 39) and 13 (46%) were nulliparous. Initial surgery was a cold-knife conization (n = 17) or loop electrosurgical excision procedure (n = 12). Twelve (41%) ECCs and 15 (52%) cone margins were histologically positive. Sixteen patients underwent a repeat conization; 13 underwent hysterectomy. Thirteen (45%) patients had residual AIS at the time of their second surgical procedure. ECC had a superior positive predictive value (100% vs 47%; P < 0.01) and negative predictive value (94% vs 57%; P = 0.01) compared to cone margin in predicting residual AIS. None of the women undergoing fertility-sparing surgery developed recurrent AIS or adenocarcinoma.
ECC performed at the time of conization may be a useful tool for predicting residual AIS in women considering fertility preservation.
确定在锥形切除术时进行宫颈管刮除术（ECC）是否是一种有用的诊断工具，用于预测可能希望保留生育能力的女性中残留的宫颈原位腺癌（AIS）。
确定了1995年至2000年在四家机构诊断为AIS的所有患者。数据从临床记录中回顾性提取。纳入统计分析的女性为：（1）年龄小于40岁；（2）在初次锥形活检时进行了ECC；（3）手术切缘在病理上界限清晰；（4）接受了第二次手术。
123例AIS患者中有29例（24%）符合纳入标准。中位年龄为33岁（范围17至39岁），13例（46%）未生育。初次手术为冷刀锥形切除术（n = 17）或环形电切术（n = 12）。12例（41%）ECC和15例（52%）锥形切缘组织学检查呈阳性。16例患者接受了再次锥形切除术；13例接受了子宫切除术。13例（45%）患者在第二次手术时仍有残留AIS。与锥形切缘相比，ECC在预测残留AIS方面具有更高的阳性预测值（100%对47%；P < 0.01）和阴性预测值（94%对57%；P = 0.01）。接受保留生育功能手术的女性均未发生复发性AIS或腺癌。
在锥形切除术时进行ECC可能是预测考虑保留生育能力女性中残留AIS的有用工具。
