Thompson Valerie, Marin Raymond
Gynaecology Department, Modbury Hospital, Modbury, South Australia, Australia.
Aust N Z J Obstet Gynaecol. 2013 Dec;53(6):571-3. doi: 10.1111/ajo.12153.
The purpose of this study was to review outcomes from LLETZ (large loop excision of the transformation zone) procedures carried out for high-grade cervical intraepithelial neoplasia (CIN), in particular findings at colposcopy, cytology and HR-HPV(high-risk human papilloma virus) result to assess whether colposcopy provides any additional information in the management of women at 12 months.
We retrospectively analysed 252 patients who had a LLETZ procedure for a HSIL (high-grade squamous intraepithelial lesion) between January 2005 and December 2010.
Eighty per cent of women who had a LLETZ procedure for HSIL were reviewed in our colposcopy clinic at 12 months after the procedure. Colposcopy at 12 months after LLETZ was documented as unsatisfactory for 30% of these women. The sensitivity of colposcopy at 12 months after LLETZ was 0.47, and the specificity was 0.95.
Colposcopy examination is an insensitive tool for detection of persisting HPV-related change after excision of high-grade CIN. Its usefulness to investigate persistent or recurrent HSIL is further reduced by the high rate of unsatisfactory colposcopy examinations after a LLETZ procedure. Papanicolaou smear and HRHPV tests may be adequate follow-up at 12 months after LLETZ for women at low risk of recurrence of HSIL.
本研究旨在回顾针对高级别宫颈上皮内瘤变（CIN）进行的宫颈环形电切术（LLETZ）的治疗效果，尤其是阴道镜检查、细胞学检查及高危型人乳头瘤病毒（HR-HPV）检测结果，以评估阴道镜检查在12个月时对女性患者管理是否能提供额外信息。
我们回顾性分析了2005年1月至2010年12月期间因高级别鳞状上皮内病变（HSIL）接受LLETZ手术的252例患者。
接受HSIL的LLETZ手术的女性患者中，80%在术后12个月到我们的阴道镜门诊接受复查。LLETZ术后12个月时，30%女性的阴道镜检查记录为不满意。LLETZ术后12个月时阴道镜检查的敏感性为0.47，特异性为0.95。
阴道镜检查是检测高级别CIN切除后持续存在的HPV相关变化的不敏感工具。LLETZ术后阴道镜检查不满意率高，进一步降低了其在调查持续性或复发性HSIL方面的效用。对于HSIL复发风险低的女性，巴氏涂片和HRHPV检测可能是LLETZ术后12个月足够的随访手段。
