Dept. Ob/Gyn S.C.P.M.G.-Fontana, Fontana, CA.
Preventive Oncology International, Cleveland Heights, OH.
J Low Genit Tract Dis. 2020 Apr;24(2):202-205. doi: 10.1097/LGT.0000000000000519.
The aim of the study was to determine which women require loop electrosurgical excision procedure (LEEP) or cervical conization (cone) to exclude cervical cancer after colposcopy for evaluation of abnormal cervical cancer screening tests yet before simple hysterectomy.
Review of electronic medical records from colposcopy clinics followed by chart review of women with cervical cancer was conducted.
Of 18,537 cervical colposcopies for evaluation of abnormal cervical cancer screening tests, 0.6% (103/18,537) had cervical cancer; of 103 women with cervical cancer, 57 had neither cervical biopsy nor endocervical curettage (ECC) showing cancer or rule-out cancer (occult cancers) and were diagnosed by subsequent LEEP (n = 22), cone (n = 31), failed cone (n = 1), or hysterectomy (n = 3). The relative risk of occult cervical cancer at colposcopy for ECC of cervical intraepithelial neoplasia (CIN) 2 or CIN 3 versus ECC not CIN 2 or CIN 3 was 51.5 (5.0% vs 0.1%), for cervical biopsy of CIN 3 versus not CIN 3, was 34.5 (3.9% vs 0.1%), and for colposcopic impression of CIN 2, CIN 3, or cancer (CIN 2+) versus impression not CIN 2+, was 8.5 (1.9% vs 0.2%). If the 10.9% (2,018/18,537) of colposcopies with ECC of CIN 2 or CIN 3, cervical biopsy of CIN 3, or colposcopic impression of CIN 2+ had subsequent LEEP or cone, 96.5% (55/57) of occult cervical cancers would be detected before hysterectomy.
After colposcopy, women with ECC of CIN 2 or CIN 3, cervical biopsy of CIN 3, or colposcopic impression of CIN 2+ require LEEP or cone before simple hysterectomy.
本研究旨在确定哪些女性在阴道镜检查后需要行环形电切术（LEEP）或宫颈锥切术（锥切术）以排除宫颈癌，这些女性的宫颈癌筛查试验异常，但又在单纯子宫切除术之前。
对阴道镜检查门诊的电子病历进行了回顾性分析，随后对宫颈癌患者的病历进行了图表回顾。
在 18537 例因宫颈癌筛查异常而行阴道镜检查的患者中，0.6%（103/18537）患有宫颈癌；在 103 例宫颈癌患者中，57 例患者未行宫颈活检或宫颈管搔刮术（ECC），但 ECC 未发现癌症或排除癌症（隐匿性癌症），随后行 LEEP（n=22）、锥切术（n=31）、锥切失败（n=1）或子宫切除术（n=3）。ECC 发现宫颈上皮内瘤变（CIN）2 或 CIN 3 与 ECC 未发现 CIN 2 或 CIN 3 相比，隐匿性宫颈癌的相对风险为 51.5（5.0%比 0.1%）；ECC 发现 CIN 3 与未发现 CIN 3 相比，隐匿性宫颈癌的相对风险为 34.5（3.9%比 0.1%）；阴道镜检查印象为 CIN 2、CIN 3 或癌症（CIN 2+）与印象为非 CIN 2+相比，隐匿性宫颈癌的相对风险为 8.5（1.9%比 0.2%）。如果将 18537 例 ECC 发现 CIN 2 或 CIN 3、宫颈活检发现 CIN 3 或阴道镜检查印象为 CIN 2+的阴道镜检查中有 10.9%（2018/18537）行 LEEP 或锥切术，那么 57 例隐匿性宫颈癌中 96.5%（55/57）可在子宫切除术前发现。
阴道镜检查后，ECC 发现 CIN 2 或 CIN 3、宫颈活检发现 CIN 3 或阴道镜检查印象为 CIN 2+的患者，在行单纯子宫切除术之前，需要行 LEEP 或锥切术。
