Pruski Dominik, Przybylski Marcin, Millert-Kalinska Sonja, Zmaczynski Andrzej, Jach Robert
Department of Obstetrics and Gynecology, District Public Hospital in Poznan, Poland.
Dominik Pruski MD. Gynecology Specialised Practise Poznan, Poland, Poland.
Ginekol Pol. 2023;94(1):12-18. doi: 10.5603/GP.a2022.0081. Epub 2022 Aug 31.
Long-term exposure to the human papillomavirus (HPV) is a known cause of squamous intraepithelial lesions that lead to cervical cancer. The loop electrosurgical excision procedure (LEEP) conization is an established treatment method. According to the latest recommendations, we present a paper to evaluate the effectiveness of various diagnostic methods of squamous intraepithelial lesions.
We analyzed 229 patients who reported to District Public Hospital in Poznan to undergo LEEP conization in 2019-2021 during the SARS-CoV-2 Pandemic. The analysis included Pap smear/liquid-based cytology, HPV genotyping, colposcopy with targeted biopsy and LEEP-conization. We offered post-treatment HPV vaccination and, as a follow-up, performed HPV re-genotyping after six months.
In total, 89.1% of patients were HPV-positive. The coloscopy-directed biopsy (CDB) results show that almost 70% of the patients had high-grade intraepithelial lesions (HSIL). The diagnosis obtained by LEEP-conization showed that half of the women were diagnosed with HSIL and one-third with the low-grade squamous intraepithelial lesion (LSIL). The sensitivity of Pap smear/LBC accounted for 93.7% and was lower than for CDB, which reached 95.1%. Both diagnostic methods tend to underestimate the final diagnosis.
The inclusion of a colposcopic examination in an in-depth diagnostic process in women with abnormal Pap smear results facilitates the identification of patients requiring therapeutic intervention. LEEP-conization may be used without the primary biopsy. It applies to multiparous women in the perimenopausal period, extensive abnormalities, discrepancies in test results, extensive visible abnormalities, and suspicion of invasive cervical cancer in the colposcopic examination.
长期感染人乳头瘤病毒（HPV）是导致鳞状上皮内病变进而引发宫颈癌的已知病因。环形电刀切除术（LEEP）锥切术是一种既定的治疗方法。根据最新建议，我们撰写本文以评估鳞状上皮内病变的各种诊断方法的有效性。
我们分析了2019年至2021年新冠疫情期间在波兹南地区公立医院接受LEEP锥切术的229例患者。分析内容包括巴氏涂片/液基细胞学检查、HPV基因分型、阴道镜检查及靶向活检和LEEP锥切术。我们为患者提供了术后HPV疫苗接种，并在六个月后进行HPV重新基因分型作为随访。
总体而言，89.1%的患者HPV呈阳性。阴道镜引导下活检（CDB）结果显示，近70%的患者患有高级别上皮内病变（HSIL）。LEEP锥切术得出的诊断结果显示，一半的女性被诊断为HSIL，三分之一被诊断为低级别鳞状上皮内病变（LSIL）。巴氏涂片/LBC的敏感性为93.7%，低于CDB，后者达到95.1%。两种诊断方法都倾向于低估最终诊断结果。
对于巴氏涂片结果异常的女性，在深入诊断过程中纳入阴道镜检查有助于识别需要进行治疗干预的患者。LEEP锥切术可在不进行初步活检的情况下使用。它适用于围绝经期经产妇、广泛异常、检查结果存在差异、广泛可见异常以及在阴道镜检查中怀疑浸润性宫颈癌的情况。
