Palmer J E, Ravenscroft S, Ellis K, Crossley J, Dudding N, Smith J H, Tidy J A
Department of Gynaecological Oncology/Jessop Wing Colposcopy Unit, Sheffield Hospitals NHS Trust, Sheffield, UK.
Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK.
Cytopathology. 2016 Jun;27(3):210-7. doi: 10.1111/cyt.12260. Epub 2015 Sep 29.
This study looks at the importance of large loop excision of the transformation zone (LLETZ) excision margins and residual cervical intraepithelial neoplasia (CIN) in women undertaking high-risk human papillomavirus (hrHPV) test of cure (TOC).
A retrospective cohort study with interval analysis performed June 2007 and June 2012 on all women undertaking treatment for CIN and subsequent hrHPV TOC 6 months post LLETZ.
Final analysis group comprised 2093 women treated by LLETZ (1396 completely excised; 697 incompletely excised). 298 out of 1794 women (13%) were hrHPV positive at TOC. Thirty-six women who failed TOC and attended colposcopy had residual CIN. No statistically significant difference existed between the completely and incompletely excised groups with regards to the detection of residual CIN at 6 months post-treatment. There was no correlation of margins of excision with hrHPV status at TOC. The overall cure rate at TOC was 98%.
TOC pathways recommend subsequent follow-up in primary care. This study identified no safety issues with TOC pathways. We can no longer assess histological failure rates at 12 months; we, therefore, recommend that this measure of treatment failure be redefined for post TOC women. It seems time to question the benefits of routine excision margins reporting, in the absence of invasion, for treated CIN. Future reporting needs to be reconsidered by the Royal College of Pathologists.
本研究探讨转化区大环形切除术（LLETZ）切缘及残余宫颈上皮内瘤变（CIN）在接受高危型人乳头瘤病毒（hrHPV）治愈性检测（TOC）的女性中的重要性。
一项回顾性队列研究，于2007年6月至2012年6月对所有接受CIN治疗并在LLETZ术后6个月进行后续hrHPV TOC检测的女性进行了间隔分析。
最终分析组包括2093例接受LLETZ治疗的女性（1396例完全切除；697例不完全切除）。1794例女性中有298例（13%）在TOC检测时hrHPV呈阳性。36例TOC检测失败并接受阴道镜检查的女性存在残余CIN。在治疗后6个月检测残余CIN方面，完全切除组和不完全切除组之间无统计学显著差异。切除切缘与TOC检测时的hrHPV状态无相关性。TOC检测时的总体治愈率为98%。
TOC方案建议在初级保健中进行后续随访。本研究未发现TOC方案存在安全问题。我们无法再评估12个月时的组织学失败率；因此，我们建议为接受TOC检测后的女性重新定义这种治疗失败的衡量标准。在没有浸润的情况下，似乎有必要质疑常规报告切除切缘对治疗CIN的益处。皇家病理学家学院需要重新考虑未来的报告方式。
