Ding Zongqun, Jiang Chunping, Shore Timothy, Pather Selvan, Dalrymple Christopher, Atkinson Kenneth, Murali Rajmohan, Al-Rayyan Ehab Salem Yousef, Luo Kehui, Carter Jonathan
Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Sydney, New South Wales, Australia.
J Obstet Gynaecol Res. 2011 Jul;37(7):754-61. doi: 10.1111/j.1447-0756.2010.01427.x. Epub 2011 Mar 13.
To study the outcome of biopsy-diagnosed cervical intraepithelial neoplasia (CIN) 2 in patients treated by loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC).
Patients (n = 131) were analyzed for histological results on LEEP/CKC specimen. Demographic and risk factors, referral cytology, high risk human papilloma virus (HR HPV) test and follow-up colposcopic clinic visits were studied.
Excisional specimens from LEEP/CKC demonstrated no CIN in 20 (15%), CIN 1 in 17 (13%), CIN 2 in 57 (44%) and CIN 3 in 37 (28%). No invasive cancers were identified. The referral Pap smear was high grade or possible high grade in 52 (40%), low grade in 59 (45%) and inconclusive in 20 (15%). Fourteen patients (11%) had positive excisional margins, eight of the 14 were tested for HR HPV infection before LEEP, and all were positive. Post-treatment HPV testing was performed at the 12-month visit in 6 of the 14 patients who had positive excision margins, and all 6 tested were negative. Two women (1.5%) with clear margins had recurrence of CIN 2, both tested positive for HR HPV after treatment.
Our data showed that a significant number of women (28%) with biopsy-diagnosed CIN 2 had CIN 1 or no dysplasia on subsequent excisional biopsy. The recurrence risk of high grade dysplasia in CIN 2 is low (1.5%). However, due to the high number of patients (72%) with high grade dysplasia at treatment biopsy, caution needs to be exercised when a conservative approach is adopted in the management of CIN 2.
研究经环形电切术（LEEP）或冷刀锥切术（CKC）治疗的活检诊断为宫颈上皮内瘤变（CIN）2级患者的治疗结果。
对131例患者的LEEP/CKC标本进行组织学结果分析。研究了人口统计学和风险因素、转诊细胞学、高危型人乳头瘤病毒（HR HPV）检测以及后续的阴道镜门诊随访情况。
LEEP/CKC切除标本显示，20例（15%）无CIN，17例（13%）为CIN 1级，57例（44%）为CIN 2级，37例（28%）为CIN 3级。未发现浸润性癌。转诊的巴氏涂片检查结果为高级别或可能为高级别的有52例（40%），低级别有59例（45%），不确定的有20例（15%）。14例患者（11%）切缘阳性，其中8例在LEEP术前进行了HR HPV感染检测，均为阳性。14例切缘阳性患者中有6例在术后12个月进行了HPV检测，检测的6例均为阴性。2例（1.5%）切缘阴性的女性CIN 2复发，治疗后HR HPV检测均为阳性。
我们的数据显示，大量活检诊断为CIN 2级的女性（28%）在后续切除活检时为CIN 1级或无发育异常。CIN 2级高级别发育异常的复发风险较低（1.5%）。然而，由于治疗活检时高级别发育异常的患者数量较多（72%），在CIN 2的管理中采用保守方法时需谨慎。
