Department of Histopathology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
Int J Gynecol Pathol. 2010 Sep;29(5):479-82. doi: 10.1097/PGP.0b013e3181dd4f76.
The relationship between dysplastic changes in the cervical epithelium and progression to in situ carcinoma and invasive carcinoma has been extensively studied. The removal of dysplastic epithelium through the long loop excision of the transformation zone (LLETZ) in 95% of the cases is curative. About 18% to 37% of LLETZ specimens with dysplasia at the margins have recurrent/residual disease. Earlier small studies suggest that the degree of dysplasia at the margins could predict for recurrence and allow a risk-based stratification of follow-up. We tested this hypothesis in a large group of women post-LLETZ for high-grade dysplasia with follow-up histology and cytology over a 12-year period. The cases were divided according to the excision margin status for dysplasia and if positive, low-grade or high-grade dysplasia. The groups were compared to assess whether the LLETZ specimens' margin status had an impact on the subsequent cytology or histology results. Positive follow-up results were defined as any grade of dysplasia in cytology or histology. Two thousand three hundred twenty-one women had LLETZs containing high-grade dysplasia over the 12-year period. One thousand five hundred thirty-four (66.1%) women had full histology and cytology follow-up available. Eight hundred twenty (53.4%) LLETZ specimens had positive margins and 714 (46.6%) had negative margins. The grade of dysplasia at the margins was available in 796 cases (97%) with 115 (15%) showing low-grade dysplasia and 680 (85%) high-grade dysplasia. One hundred seventy (20.7%) of the specimens with positive margins had positive follow-up results compared with 105 (14.7%) of the specimens with negative margins. The presence of dysplasia at an LLETZ margin is associated with dysplasia on follow-up cytology and histology (P=0.0021); however, the grade of dysplasia at the excision margin is not predictive of recurrent/residual dysplasia.
宫颈上皮的发育不良变化与原位癌和浸润性癌的进展之间的关系已经得到了广泛的研究。通过长环切除术切除转化区（LLETZ）切除发育不良上皮，在 95%的病例中是治愈性的。约 18%至 37%的 LLETZ 标本有边缘发育不良残留/复发疾病。早期的小型研究表明，边缘的发育不良程度可以预测复发，并允许基于风险的随访分层。我们在一组接受 LLETZ 治疗的高级别发育不良的妇女中进行了这项研究，随访时间为 12 年，包括组织学和细胞学检查。根据切除边缘的发育不良状态将病例进行分组，如果阳性，则分为低级别或高级别发育不良。比较各组以评估 LLETZ 标本的边缘状态是否对随后的细胞学或组织学结果有影响。阳性随访结果定义为细胞学或组织学任何级别的发育不良。在 12 年期间，有 2321 名妇女接受了含有高级别发育不良的 LLETZ。1534 名（66.1%）妇女有完整的组织学和细胞学随访资料。820 例（53.4%）LLETZ 标本边缘阳性，714 例（46.6%）边缘阴性。796 例（97%）标本边缘的发育不良程度可获得，其中 115 例（15%）为低级别发育不良，680 例（85%）为高级别发育不良。与边缘阴性标本相比，边缘阳性标本的阳性随访结果为 170 例（20.7%），105 例（14.7%）。LLETZ 边缘存在发育不良与随访细胞学和组织学的发育不良有关（P=0.0021）；然而，切除边缘的发育不良程度不能预测残留/复发的发育不良。
