Lanneau Grainger S, Skaggs Valerie, Moore Kathleen, Stowell Sean, Zuna Rosemary, Gold Michael A
The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73169, USA.
J Low Genit Tract Dis. 2007 Jul;11(3):134-7. doi: 10.1097/01.lgt.0000265776.29173.e1.
The current indications for conization of the cervix include a 2-step discrepancy between cervical cytological and histological findings. We sought to determine the utility of a loop electrocautery excision procedure (LEEP) cone for a 2-step discrepancy.
A retrospective institutional review board-approved chart review was performed on all women recommended to undergo a LEEP secondary to a discrepancy between a referral high-grade squamous intraepithelial lesion cytological finding and a subsequent colposcopic biopsy result revealing either normal or cervical intraepithelial neoplasia (CIN) 1 histological finding; CIN 2 was excluded from the study. Statistical analysis was performed using SAS 9 (SAS Institute, Inc, Cary, NC). The results were considered significant if a p value less than or equal to.05 was demonstrated.
Fifty-nine patients received a LEEP for a 2-step discrepancy between cytological and histological findings. Twenty-seven patients had a second pass or LEEP cone. Among the patients with a normal cervical biopsy result and a high-grade cytological finding, 10 (29%) of 34 had normal histological findings, as revealed by LEEP, and 14 (41%) of 34 had CIN 3; 16 (64%) of 25 patients with high-grade cytological finding and CIN 1 biopsy finding had CIN 3, as revealed by LEEP. Compared with patients with an initial normal cervical biopsy result, those with CIN 1 on initial biopsy were more likely to have CIN 3 on their LEEP findings (p =.08). Twenty-seven of 59 patients underwent a LEEP cone surgery; 1 of 27 had CIN 3 finding in the second-pass portion. This was associated with a CIN 3 identified on the first pass and associated with positive margins. The second pass of the LEEP cone failed to demonstrate CIN 96% of the time (p < .0001). Patients with a normal or a CIN 1 finding on the first pass had a normal finding on the second pass in 100% of cases.
A LEEP cone is rarely indicated for the evaluation of a 2-step discrepancy. A randomized trial of this finding is warranted.
目前宫颈锥切术的适应证包括宫颈细胞学和组织学检查结果存在两步差异。我们试图确定环形电切术（LEEP）锥切术对于两步差异的实用性。
对所有因转诊的高级别鳞状上皮内病变细胞学检查结果与随后的阴道镜活检结果显示正常或宫颈上皮内瘤变（CIN）1组织学检查结果之间存在差异而被建议接受LEEP的女性进行了一项经机构审查委员会批准的回顾性病历审查；CIN 2被排除在研究之外。使用SAS 9（SAS Institute，Inc，卡里，北卡罗来纳州）进行统计分析。如果p值小于或等于0.05，则结果被认为具有统计学意义。
59例患者因细胞学和组织学检查结果存在两步差异而接受了LEEP。27例患者进行了二次环切或LEEP锥切。在宫颈活检结果正常但细胞学检查结果为高级别的患者中，34例中有10例（29%）经LEEP显示组织学检查结果正常，34例中有14例（41%）为CIN 3；25例细胞学检查结果为高级别且活检结果为CIN 1的患者中，经LEEP显示16例（64%）为CIN 3。与最初宫颈活检结果正常的患者相比，最初活检为CIN 1的患者在LEEP检查结果中更有可能出现CIN 3（p = 0.08）。59例患者中有27例接受了LEEP锥切手术；27例中有1例在二次环切部分发现CIN 3。这与首次环切时发现的CIN 3以及切缘阳性有关。LEEP锥切的二次环切在96%的情况下未显示CIN（p < 0.0001）。首次环切结果为正常或CIN 1的患者在二次环切时100%结果正常。
LEEP锥切术很少用于评估两步差异。有必要对这一发现进行随机试验。
