Papalia Nicholas, Rohla Amanda, Tang Selphee, Nation Jill, Nelson Gregg
Department of Obstetrics and Gynaecology, University of Calgary, 1108-1500 7th Street SW, Calgary, AB, T2R 1A7, Canada.
Department of Obstetrics and Gynaecology, Alberta Health Services, Calgary, Canada.
BMC Womens Health. 2020 Feb 26;20(1):34. doi: 10.1186/s12905-020-00901-1.
The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing Human Papilloma Virus (HPV) testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP.
In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed.
Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. 31 (14%) were seen in a subsequent visit for abnormal findings. Of these, 7 (3.2%) underwent further treatment for high-grade disease/Cervical Intraepithelial Neoplasia (CIN 2/3). Of the 31, 23 (10.6%) had a third - negative - visit, resulting in discharge from colposcopy. One patient had a repeat LEEP for persistent Low-Grade Squamous Intraepithelial Lesion (LSIL).
In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.
宫颈癌筛查的目标是识别发育异常病变以便后续切除，从而预防浸润性疾病。对于治疗后如何最佳地对女性进行疾病监测存在临床权衡，一些加拿大省份仅进行阴道镜检查，而另一些省份除宫颈细胞学检查外还利用人乳头瘤病毒（HPV）检测。环形电切术（LEEP）用于治疗HPV介导的癌前病变，疾病切除后通常对患者随访12个月。本研究旨在量化在除LEEP外还采用激光消融的实际诊疗环境中，第二次阴道镜随访时高级别疾病的患病率。
在一项回顾性队列研究中，通过艾伯塔省卡尔加里市汤姆·贝克癌症中心的电子病历系统ARIA，查阅2010年1月至2015年12月期间的连续患者病历。提取数据并使用REDCap数据库从符合纳入标准的病历中汇编相关信息。进行描述性和分析性统计。
在确定的303例患者中，221例符合纳入标准。这些患者中有86%在第二次随访后达到阴道镜检查出院标准。31例（14%）因异常发现进行了后续检查。其中，7例（3.2%）因高级别疾病/宫颈上皮内瘤变（CIN 2/3）接受了进一步治疗。在这31例患者中，23例（10.6%）第三次检查结果为阴性，从而从阴道镜检查中出院。1例患者因持续性低级别鳞状上皮内病变（LSIL）再次接受了LEEP治疗。
总之，我们的数据表明，在一个经常将激光消融与LEEP联合用于治疗大病变的环境中，治疗后第二次阴道镜随访时高级别疾病的患病率为3.2%。该复发率与大多数已发表的关于CIN2/3复发率的文献一致。
