Kamio Masaki, Yanazume Shintaro, Togami Shinichi, Kobayashi Hiroaki
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan.
J Obstet Gynaecol India. 2021 Feb;71(1):66-71. doi: 10.1007/s13224-020-01368-8. Epub 2020 Sep 10.
This study aimed to examine the associations of cone margin and human papillomavirus (HPV) status after conization with cytological abnormalities and disease recurrence in patients with cervical intraepithelial neoplasia grade 3 (CIN3).
This is a retrospective study of 366 women with CIN3 who underwent conization at Kagoshima University Hospital between 2004 and 2017. Conization was performed using an ultrasonic scalpel. The polymerase chain reaction for detecting HPV genotypes was performed using fresh cervical cell samples. We examined the associations of margin status and HPV status after conization with cytological abnormalities and recurrence.
Among 224 women with CIN3, 193 (86.2%) underwent HPV genotype testing before conization. The HPV-positive rate was 84.9%. The most common HPV genotypes before conization were HPV 16, 31, 58, 52, 18, 35, and 33. In 191 patients, the uterus was preserved after conization. Sixteen patients had pathologically positive margins, 165 had negative margins, and 10 had unclear margins. There was no significant difference in abnormal cytology and recurrence rate after conization between the three groups. Five patients with positive margins and abnormal cytology during follow-ups were HPV16- or HPV58-positive in the preoperative HPV testing. Of the 191 women, 91 (47.6%) underwent pre- and postoperative HPV genotype testing, among whom 14 (15.4%) were HPV-positive after conization. No significant difference in abnormal cytology based on HPV status after conization was found. The recurrence rate tended to be higher in HPV-positive patients than in HPV-negative patients after conization (21.4% vs. 1.3%, < 0.05). Three patients with HPV positivity after conization and recurrence during follow-up were HPV16- or HPV58-positive.
HPV positivity after conization for CIN3 was associated with a high recurrence rate, especially in HPV16- and HPV58-positive patients. HPV58 has not received much attention thus far, but abnormalities in cytology and recurrence may be as likely as those associated with HPV16. Thus, a careful follow-up in such patients is recommended.
本研究旨在探讨宫颈上皮内瘤变3级（CIN3）患者锥切术后切缘情况与人乳头瘤病毒（HPV）状态与细胞学异常及疾病复发之间的关联。
这是一项对2004年至2017年间在鹿儿岛大学医院接受锥切术的366例CIN3女性患者的回顾性研究。使用超声刀进行锥切术。采用新鲜宫颈细胞样本进行检测HPV基因型的聚合酶链反应。我们研究了锥切术后切缘状态和HPV状态与细胞学异常及复发之间的关联。
在224例CIN3女性患者中，193例（86.2%）在锥切术前进行了HPV基因型检测。HPV阳性率为84.9%。锥切术前最常见的HPV基因型为HPV 16、31、58、52、18、35和33。191例患者锥切术后保留了子宫。16例患者病理切缘阳性，165例切缘阴性，10例切缘情况不明。三组之间锥切术后细胞学异常和复发率无显著差异。随访期间5例切缘阳性且细胞学异常的患者术前HPV检测为HPV16或HPV58阳性。在191例女性中，91例（47.6%）进行了术前和术后HPV基因型检测，其中14例（15.4%）锥切术后HPV阳性。未发现锥切术后基于HPV状态的细胞学异常有显著差异。锥切术后HPV阳性患者的复发率往往高于HPV阴性患者（21.4%对1.3%，P＜0.05）。3例锥切术后HPV阳性且随访期间复发的患者为HPV16或HPV58阳性。
CIN3锥切术后HPV阳性与高复发率相关，尤其是HPV16和HPV58阳性患者。HPV58迄今为止尚未受到太多关注，但细胞学异常和复发情况可能与HPV16相关者一样。因此，建议对此类患者进行密切随访。
