Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, 00029 Helsinki, Finland.
Department of Obstetrics and Gynecology, Hyvinkää Hospital, HUCH and University of Helsinki, 05850 Hyvinkää, Finland.
Gynecol Oncol. 2022 Nov;167(2):167-173. doi: 10.1016/j.ygyno.2022.09.016. Epub 2022 Sep 22.
The gold standard of cervical intraepithelial neoplasia (CIN) treatment is large loop excision of the transformation zone (LLETZ) after histopathological diagnosis from punch biopsies. In addition, treatment may be appropriate at initial colposcopy. Our objective was to study the applicability of immediate treatment strategy according to clinical parameters.
We conducted a prospective cohort study among patients referred to colposcopy at Helsinki University Hospital, Finland, between January 2014, and September 2018 (ISRCTN10933736). Patients treated with LLETZ, either after biopsies or immediately at initial colposcopy, were included. The main outcome measure was overtreatment (OT) rate defined as normal or low-grade histopathological findings in LLETZ specimen within both treatment groups.
A total of 572 patients treated with LLETZ were included: 360 treated after biopsies and 212 treated immediately at initial colposcopy. When LLETZ was performed immediately after high-grade referral cytology and with colposcopic impression of high-grade disease, the overtreatment (OT) rate was 10.0% (95% CI 9.10 to 17.2), whereas when LLETZ was done after biopsy-confirmed high-grade lesions, the OT rate was 18.9% (95% CI 14.7 to 23.7), resulting in risk difference (RD) -8.91% (95% CI -16.0 to -1.82). Among HPV16/18 positive patients the OT rate was 8.22% (95% CI 3.08 to 17.0) for immediate treatment, resulting in RD of -10.7% (95% CI -18.3 to -3.04) compared to LLETZ after biopsies.
Immediate LLETZ does not result in overtreatment when applied on selected cases, especially after high-grade referral cytology and when high-grade lesion is also colposcopically suspected.
宫颈上皮内瘤变（CIN）的金标准治疗方法是在巴氏活检的组织病理学诊断后进行大环形电切术（LLETZ）。此外，在初始阴道镜检查时也可能需要进行治疗。我们的目的是研究根据临床参数制定即时治疗策略的适用性。
我们在芬兰赫尔辛基大学医院进行了一项前瞻性队列研究，研究对象为 2014 年 1 月至 2018 年 9 月间转诊至阴道镜检查的患者（ISRCTN10933736）。纳入接受 LLETZ 治疗的患者，包括在活检后和直接在初始阴道镜检查时进行 LLETZ 治疗的患者。主要观察指标为过度治疗（OT）率，定义为两组治疗中 LLETZ 标本的组织病理学发现为正常或低级别病变。
共纳入 572 例接受 LLETZ 治疗的患者：360 例在活检后接受治疗，212 例在初始阴道镜检查时直接接受治疗。当高级别转诊细胞学检查后立即进行 LLETZ 且阴道镜检查印象为高级别疾病时，过度治疗（OT）率为 10.0%（95%CI9.10 至 17.2），而当 LLETZ 用于活检证实的高级别病变时，OT 率为 18.9%（95%CI14.7 至 23.7），风险差异（RD）为-8.91%（95%CI-16.0 至-1.82）。在 HPV16/18 阳性患者中，立即治疗的 OT 率为 8.22%（95%CI3.08 至 17.0），与活检后行 LLETZ 相比，RD 为-10.7%（95%CI-18.3 至-3.04）。
在选定病例中，尤其是在高级别转诊细胞学检查后，并且当高级别病变也在阴道镜检查中怀疑时，立即进行 LLETZ 治疗不会导致过度治疗。
