Walavalkar Vighnesh, Stockl Thomas, Owens Christopher L, Manning Mark, Papa Debra, Li Anjie, Khan Ashraf, Liu Yuxin
From the Departments of Pathology.
Obstetrics & Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester.
Am J Clin Pathol. 2016 Jan;145(1):96-100. doi: 10.1093/ajcp/aqv007.
To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone).
We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported.
Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%).
We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.
探讨宫颈锥切标本中未发现目标高级别鳞状上皮内病变（阴性锥切）的意义。
我们研究了540例锥切手术：400例阳性锥切和140例阴性锥切。报告了临床病理特征和2年随访结果。
阴性锥切占CIN2或更高活检引发手术的22%。细胞学引发的手术中阴性锥切的比例更高（高级别鳞状上皮内病变[HSIL]为37%，非典型鳞状细胞-不能排除高级别鳞状上皮内病变[ASC-H]为46%，低级别鳞状上皮内病变-不能排除高级别鳞状上皮内病变[LSIL-H]为76%）。在复查阴性切除引发的活检和细胞学检查时，我们将24例（24%）CIN2活检、3例（14%）HSIL、5例（83%）ASC-H和12例（92%）LSIL-H进行了降级。我们三分之一的阴性锥切可归因于活检或细胞学检查的过度诊断。阴性锥切的患者年龄较大，切除范围较小，阴道镜检查结果为阴性，高危型人乳头瘤病毒（HR-HPV）检测结果为阴性或不确定。在2年内，35例（25%）阴性锥切的女性出现了非典型鳞状细胞未明确意义（ASCUS）或低级别鳞状上皮内病变（LSIL）。只有1例（0.7%）复发为CIN3，这一比例显著低于阳性锥切的女性（13%）。
我们主张对所有切除引发的活检和细胞学检查进行仔细复查，尤其是在LSIL-H的病例中。阴性锥切的患者应进行细胞学检查和HR-HPV检测。
