Lili Eleftheria, Chatzistamatiou Kimon, Kalpaktsidou-Vakiani Andromachi, Moysiadis Theodoros, Agorastos Theodoros
4th Department of Obstetrics and Gynecology.
2nd Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki.
Medicine (Baltimore). 2018 Jan;97(4):e9719. doi: 10.1097/MD.0000000000009719.
The aim of the present cohort study was to assess the long-term (follow-up period up to 22 years) recurrence rate of preinvasive disease and the newly detected invasive disease rate in a cohort of women treated with excisional methods for high-grade cervical intraepithelial neoplasia (CIN).Women treated with large loop excision of the transformation zone (LLETZ) and cold knife conization (CKC) for histologically proven high-grade CIN were followed up for up to 22 years. Surgical specimens underwent histological examination and the status of endocervical as well as ectocervical margins was recorded. Follow-up protocol included conventional Pap test, colposcopy and pelvic examination at 3, 6, and 12 months after the initial treatment, and every 12 months thereafter, provided that the results were normal. In case of high-grade cytological findings and/or atypical colposcopic impression, multiple punch biopsies were taken in order to verify or exclude recurrent disease.In total, 804 women were followed for a mean time of 77.1 months (range: 6-266). LLETZ was used in 569 (70.7%) and CKC in 235 cases (29.2%). No woman developed invasive cervical cancer. Recurrent high-grade disease, developed in 9 women (1.1%, 95% confidence interval 0.5-2.2). Median treatment-to-recurrence time was 46.5 months (range: 6-235.3). One woman treated for squamous CIN2 on clear margins developed adenocarcinoma in situ 59.2 months post-treatment.Women having undergone excisional treatment for high-grade CIN indicate a very low risk for recurrent disease and potentially negligible risk for invasive cancer, provided that a strict and vigorous follow-up is offered after treatment.
本队列研究的目的是评估一组接受切除性治疗的高级别宫颈上皮内瘤变（CIN）女性患者的癌前病变长期复发率（随访期长达22年）以及新检测到的浸润性疾病发生率。对经组织学证实为高级别CIN且接受转化区大环形切除术（LLETZ）和冷刀锥切术（CKC）治疗的女性进行了长达22年的随访。手术标本进行了组织学检查，并记录了宫颈管和宫颈外口切缘的情况。随访方案包括在初始治疗后3、6和12个月进行常规巴氏试验、阴道镜检查和盆腔检查，此后如果结果正常则每12个月进行一次。如果出现高级别细胞学检查结果和/或非典型阴道镜印象，则进行多次活检以证实或排除复发性疾病。
总共对804名女性进行了随访，平均随访时间为77.1个月（范围：6 - 266个月）。569例（70.7%）使用了LLETZ，235例（29.2%）使用了CKC。没有女性发生浸润性宫颈癌。9名女性（1.1%，95%置信区间0.5 - 2.2）出现了复发性高级别疾病。治疗至复发的中位时间为46.5个月（范围：6 - 235.3个月）。一名切缘清晰的鳞状CIN2患者在治疗后59.2个月发生了原位腺癌。
接受高级别CIN切除性治疗的女性复发疾病风险非常低，浸润性癌风险可能可忽略不计，前提是治疗后提供严格且积极的随访。
