Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Lasers Surg Med. 2022 Oct;54(8):1099-1106. doi: 10.1002/lsm.23585. Epub 2022 Jul 11.
To evaluate the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of patients with positive margin in comparison to regular follow-up, and a repeat cervical conization.
A retrospective analysis was conducted using 83 patients with pathologically confirmed high-grade cervical intraepithelial neoplasia (CIN) with a positive margin after conization. The management methods and patient prognosis were analyzed and compared.
Thirty-five, 33, and 15 patients were treated for regular follow-up, ALA-PDT, and a repeat cervical conization, respectively. About 33.3% (5/15) patients had residual lesions of low-grade CIN and above after recognization. The clinical characteristics of patients in the three groups were similar. The residual lesion rates of patients selected for follow-up, ALA-PDT, and recognization were 34.3% (12/35), 9.1% (3/33), and 0% (0/15), respectively, at 6-month follow-up (p = 0.004). The HPV clearance rates were 31.3%, 66.7%, and 84.6%, respectively (p = 0.01). Further analysis showed that a positive margin in the inscribed margin of the cervical canal (p = 0.022) and persistent HR-HPV positive tests after initial conization (p = 0.003) significantly increased the risk of residual disease. At 2-year follow-up, the recurrence rates of lesions were 3.3% and 26.1% in the ALA-PDT and follow-up groups, respectively (p = 0.021). Notably, the recurrence rates were not significantly different between the ALA-PDT and recognization groups (3.3% vs. 6.7%) (p = 0.561).
ALA-PDT is an effective treatment for patients with a positive margin after cervical conization for high-grade CIN. Compared with regular follow-up, ALA-PDT can reduce residual and recurrence rate. Moreover, there was no significant difference in the efficacy between AlA-PDT and recognization.
评估 5-氨基酮戊酸光动力疗法（ALA-PDT）治疗阳性切缘患者的临床疗效和安全性，并与常规随访和再次宫颈锥切进行比较。
对 83 例经病理证实为高级别宫颈上皮内瘤变（CIN）且宫颈锥切术后切缘阳性的患者进行回顾性分析，比较分析不同处理方法及患者预后。
分别对 35 例、33 例和 15 例患者进行常规随访、ALA-PDT 和再次宫颈锥切。再次锥切患者中有 33.3%（5/15）发现残留病变为低级别 CIN 及以上。三组患者的临床特征相似。选择随访、ALA-PDT 和再次锥切的患者的残留病变率分别为 34.3%（12/35）、9.1%（3/33）和 0%（0/15），6 个月随访时差异有统计学意义（p=0.004）。HPV 清除率分别为 31.3%、66.7%和 84.6%（p=0.01）。进一步分析显示宫颈管内口切缘阳性（p=0.022）和初始锥切后 HR-HPV 持续阳性（p=0.003）显著增加残留疾病的风险。2 年随访时，ALA-PDT 组和随访组的病变复发率分别为 3.3%和 26.1%（p=0.021）。值得注意的是，ALA-PDT 组和再次锥切组的复发率无显著差异（3.3% vs. 6.7%）（p=0.561）。
ALA-PDT 是治疗高级别 CIN 宫颈锥切术后阳性切缘的有效方法，与常规随访相比，ALA-PDT 可降低残留病变和复发率，且与再次锥切相比，疗效无显著差异。
