Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona) - Hospital Clinic, University of Barcelona, Barcelona, Spain.
J Low Genit Tract Dis. 2018 Oct;22(4):367-374. doi: 10.1097/LGT.0000000000000410.
The aim of the study was to assess the accuracy of colposcopy evaluation at the time of the loop electrosurgical excision procedure (LEEP) to identify women with a previous confirmatory diagnosis of squamous intraepithelial lesion/cervical intraepithelial neoplasia (SIL/CIN) with low probability of dysplasia in the LEEP specimen.
We prospectively recruited a cohort of 162 women undergoing LEEP for histological high-grade SIL/CIN 2-3 or low-grade SIL/CIN 1 with high-grade SIL cytology showing a fully visible squamocolumnar junction in the colposcopy evaluation at the time of LEEP. At the referral visit cervical cytology, human papillomavirus and genotype detection, digital colposcopy, colposcopical lesion measurement, and 1 or more biopsies of the transformation zone were obtained. The uterine cervix was colposcopically evaluated intraoperatively.
Thirty-four women (21.0%) had a normal colposcopy evaluation at the time of the LEEP, whereas the remaining 128 women showed abnormal findings. Absence of SIL/CIN in the LEEP specimen was confirmed in 28 (82.3%) of the 34 women with a normal colposcopy at the time of LEEP group and 8 (3.1%) of the 128 women showing abnormal colposcopy at the time of LEEP group (p < .001). A normal colposcopic evaluation at the time of LEEP was associated with an increase in the risk of absence of lesion in the cone specimen compared with cases presenting an abnormal colposcopy (95% CI = 33.8-1,555.1, p < .001). The colposcopy evaluation at the time of LEEP had a positive predictive value of 82.3% (95% CI = 66.5-91.5) and a negative predictive value of 96.9% (95% CI = 92.2-98.8) to predict low probability of SIL/CIN in the specimen.
Colposcopic evaluation at the time of LEEP seems to be accurate to identify SIL/CIN postbiopsy regression; thus, its performance would be considered at the time of the treatment.
本研究旨在评估阴道镜检查在环形电切术（LEEP）时的准确性，以识别那些在 LEEP 标本中低度上皮内瘤变（SIL/CIN）的具有先前确诊鳞状上皮内病变/宫颈上皮内瘤变（SIL/CIN）的女性。
我们前瞻性招募了一组 162 名女性，她们因组织学高级别 SIL/CIN 2-3 或低级别 SIL/CIN 1 而接受 LEEP 治疗，且高级别 SIL 细胞学显示 LEEP 时阴道镜检查时完全可见的鳞-柱状交界。在转诊时，获取宫颈细胞学、人乳头瘤病毒和基因型检测、数字阴道镜、阴道镜下病变测量以及 1 个或更多的转化区活检。术中对子宫颈进行阴道镜检查。
34 名女性（21.0%）在 LEEP 时阴道镜检查正常，而其余 128 名女性表现出异常。在 LEEP 时阴道镜检查正常的 34 名女性中，28 名（82.3%）在 LEEP 标本中无 SIL/CIN，而在 LEEP 时阴道镜检查异常的 128 名女性中，8 名（3.1%）有 SIL/CIN（p<0.001）。与表现出异常阴道镜的病例相比，在 LEEP 时正常的阴道镜检查与锥切标本中无病变的风险增加相关（95%CI=33.8-1,555.1，p<0.001）。LEEP 时的阴道镜检查的阳性预测值为 82.3%（95%CI=66.5-91.5），阴性预测值为 96.9%（95%CI=92.2-98.8），可预测标本中 SIL/CIN 的低概率。
LEEP 时的阴道镜检查似乎可以准确识别活检后 SIL/CIN 的消退；因此，在治疗时应考虑其表现。
