Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
Department of Biomedical Sciences, University of Dschang, Dschang District Hospital, Dschang, Cameroon.
JCO Glob Oncol. 2023 Feb;9:e2200241. doi: 10.1200/GO.22.00241.
Thermal ablation (TA) has become the conventional method for treatment of precancerous cervical lesions in low-resource settings. After TA, both the squamocolumnar junction (SCJ) and the transformation zone (TZ) may be subject to change. Our aim was to evaluate SCJ and TZ variability after TA.
Study data were collected in a large prospective trial of a cervical cancer screening campaign in Cameroon. For each patient, two sets of cervical photos (native and with acetic acid) were taken before and 6-12 months after TA. The SCJ and TZ were evaluated independently by three observers according to the WHO nomenclature. When discordances were observed between the type of TZ and SCJ selected by each observer, a corrected TZ was established on the basis of the SCJ categorization. Interobserver agreement for TZ interpretation was evaluated using Cohen's kappa coefficient for agreement between two observers and Fleiss' kappa between three observers.
Fifty consecutive participants were included in the analysis. Seventy-six percent were interpreted as TZ1-2, and 24% as TZ3 before TA. In 56% of cases, the entire SCJ could not be entirely visualized after TA, thus being recategorized as TZ3. Interobserver agreement was fair for diagnosis before TA (Kappa coefficient, 0.34; 95% CI, 0.27 to 0.45) and moderate for diagnosis after TA (Kappa coefficient, 0.40; 95% CI, 0.30 to 0.50). After TA, 36% progressed from TZ1-2 to TZ3, with a moderate interobserver agreement (Kappa coefficient, 0.44; 95% CI, 0.40 to 0.54).
We observed a shift of the SCJ into the endocervical canal after TA. A significant proportion of participants had TZ 3 after treatment, raising the question of visual inspection with acetic acid's applicability as a first-line follow-up examination method after TA.
热消融（TA）已成为资源匮乏环境下治疗癌前宫颈病变的常规方法。TA 后，鳞柱状交界（SCJ）和转化区（TZ）都可能发生变化。本研究旨在评估 TA 后 SCJ 和 TZ 的可变性。
研究数据来自喀麦隆一项大规模宫颈癌筛查活动的前瞻性试验。对每位患者，在 TA 前后分别采集两组宫颈照片（原始和醋酸）。三位观察者根据世卫组织命名法独立评估 SCJ 和 TZ。当每位观察者选择的 TZ 和 SCJ 类型不一致时，根据 SCJ 分类建立校正 TZ。采用两位观察者之间的 Cohen's kappa 系数和三位观察者之间的 Fleiss' kappa 系数评估 TZ 解释的观察者间一致性。
连续 50 名参与者纳入分析。76%的参与者在 TA 前被归类为 TZ1-2，24%的参与者被归类为 TZ3。在 56%的病例中，TA 后无法完全观察到整个 SCJ，因此被重新归类为 TZ3。TA 前的诊断观察者间一致性为一般（Kappa 系数，0.34；95%置信区间，0.27 至 0.45），TA 后的诊断观察者间一致性为中度（Kappa 系数，0.40；95%置信区间，0.30 至 0.50）。TA 后，36%的患者从 TZ1-2进展为 TZ3，观察者间一致性为中度（Kappa 系数，0.44；95%置信区间，0.40 至 0.54）。
我们观察到 TA 后 SCJ 向宫颈管内移位。相当一部分患者在治疗后出现 TZ3，这引发了关于醋酸视觉检查作为 TA 后一线随访检查方法的适用性问题。
