Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark.
Department of Clinical Medicine, Aarhus University, Herning, Denmark.
BJOG. 2022 Dec;129(13):2132-2140. doi: 10.1111/1471-0528.17200. Epub 2022 May 26.
To compare the proportion of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in cervical biopsies with that in large loop excision of the transformation zone (LLETZ) specimens in women aged ≥45 years with transformation zone type 3 (TZ3).
Multicentre cross-sectional study.
Three colposcopy clinics in the Central Denmark Region.
Women aged ≥45 years referred to colposcopy as a result of a positive human papillomavirus (HPV) test and/or abnormal cytology and with TZ3 at colposcopy.
Women had multiple biopsies taken and an LLETZ was performed.
Histologically confirmed CIN2+ in biopsies compared with that in LLETZ specimens.
Of 166 eligible women at colposcopy, 102 women with paired data from biopsies and LLETZ specimens were included for final analysis. The median age was 67.7 years (IQR 62.6-70.4 years), and most were postmenopausal (94.1%) and had undergone HPV-based screening (81.3%). The CIN2+ detection rate was significantly higher in LLETZ specimens than in biopsies (32.4% vs 14.7%, difference 17.7%, 95% CI 6.3-29.0%), resulting in more than half of CIN2+ cases being missed in biopsies (54.5%, 95% CI 36.4-71.9%). The overall agreement between biopsies and LLETZ was 82.4% (95% CI 73.6-89.2%).
CIN2+ detection is underestimated in women aged ≥45 years with TZ3 if detection relies on the results of biopsies alone. To reduce the risk of underdiagnosis and overtreatment, future studies should explore the use of new biomarkers for risk stratification to improve discrimination between women at increased risk of CIN2+ who need to undergo LLETZ and women who may undergo follow-up.
比较≥45 岁转化区（TZ）3 型妇女宫颈活检与大环形电切术（LLETZ）标本中宫颈上皮内瘤变 2 级或以上（CIN2+）的比例。
多中心横断面研究。
丹麦中部地区的 3 个阴道镜检查诊所。
因 HPV 检测阳性和/或细胞学异常且阴道镜检查 TZ3 而转诊阴道镜检查的≥45 岁妇女。
对这些妇女进行多次活检，并进行 LLETZ 手术。
活检与 LLETZ 标本组织学证实的 CIN2+比较。
在阴道镜检查的 166 名符合条件的妇女中，102 名妇女的活检和 LLETZ 标本具有配对数据，最终纳入了 102 名妇女进行最终分析。中位年龄为 67.7 岁（IQR 62.6-70.4 岁），大多数为绝经后（94.1%），并接受过 HPV 为基础的筛查（81.3%）。LLETZ 标本中的 CIN2+检出率明显高于活检（32.4%比 14.7%，差异 17.7%，95%CI 6.3-29.0%），导致活检中超过一半的 CIN2+病例漏诊（54.5%，95%CI 36.4-71.9%）。活检和 LLETZ 之间的总一致性为 82.4%（95%CI 73.6-89.2%）。
如果仅依靠活检结果进行检测，≥45 岁 TZ3 型妇女的 CIN2+检出率会被低估。为了降低漏诊和过度治疗的风险，未来的研究应探索使用新的生物标志物进行风险分层，以提高需要接受 LLETZ 的 CIN2+风险增加妇女与可能接受随访的妇女之间的区分度。
