Cui Yiwen, Sangi-Haghpeykar Haleh, Patsner Bruce, Bump Jennifer M M, Williams-Brown Marian Y, Binder Gary L, Masand Ramya P, Anderson Matthew L
Departments of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
INOVA Women's Hospital, Falls Church, VA 22042, USA.
Gynecol Oncol. 2017 Mar;144(3):547-552. doi: 10.1016/j.ygyno.2017.01.007. Epub 2017 Jan 9.
To assess the role of additional biopsies performed with loop electrosurgical excisional procedure (LEEP) in predicting the likelihood of persistent high grade intraepithelial neoplasia.
Clinicopathologic data were abstracted from women who underwent excision of high grade intraepithelial lesions between 2001 and 2014. Persistent disease was defined as uninterrupted high grade intraepithelial neoplasia, whereas recurrent disease was defined as disease diagnosed ≥1year after treatment with intervening normal evaluation. Chi-square and Fisher's exact tests were used to examine associations between demographic and histologic parameters and clinical outcomes.
A total of 606 women underwent LEEP for high grade intraepithelial neoplasia (HSIL), of whom, 178 (29%) were additionally evaluated by endocervical curettage, 80 (13%), top hat and 99 (16%), both procedures. With mean follow-up of 1.9±1.5years, persistent disease was identified in 87 women (14%) while recurrent disease was diagnosed in 20 (3%). After adjusting for age, HIV status and histologic grade of disease, the presence of disease at the endocervical margin (aOR=2.2, 95% CL 1.8-5.5, p<0.0001), with endocervical curettage (aOR=2.39, 95% CL 1.2-9.9, p=0.025) or on top hat (aOR=4.0, 95% CL 1.1-16.2, p=0.04) correlated with the likelihood of persistent but not recurrent disease. Only endocervical margin status remained predictive (p=0.03) of outcome after controlling for pre-procedure likelihood of endocervical disease. Sensitivity of endocervical margin status for persistent disease was 56.9% with specificity of 72.2%. Positive predictive value (PPV) was 24.9% and negative predictive value (NPV) 90.9%.
Despite frequent use of additional procedures to sample the endocervix, these strategies do not improve the ability of endocervical margin status to predict persistent or recurrent dysplasia.
评估在宫颈环形电切术（LEEP）中进行额外活检对预测持续性高级别上皮内瘤变可能性的作用。
从2001年至2014年间接受高级别上皮内病变切除的女性中提取临床病理数据。持续性疾病定义为不间断的高级别上皮内瘤变，而复发性疾病定义为治疗后≥1年诊断出的疾病，期间有正常评估。采用卡方检验和Fisher精确检验来检查人口统计学和组织学参数与临床结果之间的关联。
共有606名女性因高级别上皮内瘤变（HSIL）接受了LEEP，其中178名（29%）还接受了宫颈管刮除术评估，80名（13%）接受了“顶帽”活检，99名（16%）同时接受了这两种检查。平均随访1.9±1.5年，87名女性（14%）被确诊为持续性疾病，20名（3%）被诊断为复发性疾病。在调整年龄、HIV状态和疾病组织学分级后，宫颈管切缘存在病变（校正比值比[aOR]=2.2，95%可信区间[CL]1.8 - 5.5，p<0.0001）、宫颈管刮除术发现病变（aOR=2.39，95%CL 1.2 - 9.9，p=0.025）或“顶帽”活检发现病变（aOR=4.0，95%CL 1.1 - 16.2，p=0.04）与持续性疾病的可能性相关，但与复发性疾病无关。在控制宫颈管疾病的术前可能性后，只有宫颈管切缘状态仍然是结果的预测因素（p=0.03）。宫颈管切缘状态对持续性疾病的敏感性为56.9%，特异性为72.2%。阳性预测值（PPV）为24.9%，阴性预测值（NPV）为90.9%。
尽管频繁使用额外的方法对宫颈管进行取样，但这些策略并未提高宫颈管切缘状态预测持续性或复发性发育异常的能力。
