Tran Phuong Lien, Kenfack Bruno, Tincho Foguem Eveline, Viviano Manuela, Temogne Liliane, Tebeu Pierre-Marie, Catarino Rosa, Benski Anne-Caroline, Vassilakos Pierre, Petignat Patrick
Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
Int J Womens Health. 2017 Dec 1;9:879-886. doi: 10.2147/IJWH.S142911. eCollection 2017.
Treating cervical intraepithelial neoplasia (CIN) grades 2 and 3 is the recommended strategy for preventing invasive carcinoma in low- and middle-income countries (LMICs). Our objective was to assess the efficacy of thermoablation in the treatment of CIN2 and CIN3 in a screen-and-treat approach.
Women aged 30-49 years in Dschang, Cameroon, were invited to undergo vaginal sampling for human papillomavirus (HPV), samples being assessed by an Xpert HPV Assay. HPV-positive women underwent visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI), cervical biopsy, and endocervical curettage. Women positive for HPV-16/18/45 or other HPV types with abnormal VIA/VILI were treated by thermoablation on the same day. The primary outcome was persistence of high-grade disease on cytologic examination at 12 months.
Of a total of 1,012 recruited women, 188 were HPV-positive, 121 patients required thermoablation, and 99 had a CIN of grade <2, making the overtreatment rate 9.9%. The cure rate for CIN2 and CIN3 at 12 months was 70.6%. Failure (higher risk of persistent disease) was associated with the presence of occult endocervical lesions at baseline diagnosis (adjusted odds ratio [aOR] =128.97 [95% confidence interval [CI], 8.80-1,890.95]; <0.0001). First sexual intercourse before the age of 15 was also a risk factor (aOR =0.003 [95% CI, 0.001-0.61]; =0.023).
In LMICs, use of thermoablation in a screen-and-treat approach is a valuable treatment option for CIN2 and CIN3. Studies comparing thermoablation with cryotherapy are needed to determine the most appropriate treatment for cervical precancer in such countries.
在低收入和中等收入国家（LMICs），治疗宫颈上皮内瘤变（CIN）2级和3级是预防浸润癌的推荐策略。我们的目的是评估热消融在筛查和治疗方法中治疗CIN2和CIN3的疗效。
邀请喀麦隆雅温得30至49岁的女性进行人乳头瘤病毒（HPV）阴道采样，样本通过Xpert HPV检测进行评估。HPV阳性女性接受醋酸目视检查（VIA）和卢戈氏碘目视检查（VILI）、宫颈活检和宫颈管刮除术。HPV-16/18/45阳性或其他HPV类型且VIA/VILI异常的女性在同一天接受热消融治疗。主要结局是12个月时细胞学检查高级别疾病的持续存在。
在总共1012名招募的女性中，188名HPV阳性，121名患者需要热消融，99名CIN级别<2，过度治疗率为9.9%。12个月时CIN2和CIN3的治愈率为70.6%。失败（持续性疾病风险较高）与基线诊断时存在隐匿性宫颈管病变相关（调整比值比[aOR]=128.97[95%置信区间[CI]，8.80-1890.95]；<0.0001）。15岁之前首次性交也是一个风险因素（aOR=0.003[95%CI，0.001-0.61]；=0.023）。
在低收入和中等收入国家，在筛查和治疗方法中使用热消融是治疗CIN2和CIN3的一种有价值的治疗选择。需要进行比较热消融与冷冻疗法的研究，以确定这些国家宫颈上皮内瘤变的最合适治疗方法。
