Department of Obstetrics and Gynecology, Martini Hospital Groningen, Groningen, the Netherlands.
Department of Pathology, Martini Hospital Groningen, Groningen, the Netherlands.
Int J Gynaecol Obstet. 2023 Oct;163(1):140-147. doi: 10.1002/ijgo.14888. Epub 2023 May 26.
A new guideline on population-screening cervical cytology was introduced to improve diagnosis and management of (pre-)malignant cervical lesions. Subsequently, more colposcopies and more large loop excision of the transformation zone (LLETZ) were performed. There is little information about the relevance of positive margins for cervical intraepithelial neoplasia (CIN) after LLETZ. This study assesses the clinical relevance of margins on the presence of CIN.
In this retrospective study, 567 women who had undergone LLETZ due to cervical dysplasia between January 2017 and December 2019 in Martini Hospital Groningen were included. The primary outcome was the persistence of cervical dysplasia (Pap ≥2) in relation to excisional margins. A χ test was performed and hazard ratios with 95% confident intervals (CIs) were reported.
After median follow-up of 14 months, 9% (N = 28) with affected margins and 4% (N = 9) with clear margins had persistent cervical dysplasia (P = 0.044). Positive human papillomavirus (HPV) status was an independent risk factor (hazard ratio [HR] 8.97, 95% confidence interval [CI] 4.19-19.22). Women with affected margins and of older age were less prone to clear HPV (P < 0.001).
Women treated with LLETZ for cervical dysplasia show favorable long-term outcomes, with low residual rate. High-risk HPV combined with excisional margin status and age appears to be an adequate risk stratification and individualized management might be based on these factors.
引入新的人群筛查宫颈细胞学指南，以改善（前）恶性宫颈病变的诊断和管理。随后，更多的阴道镜检查和更多的环形电切术（LLETZ）被实施。关于 LLETZ 后宫颈上皮内瘤变（CIN）阳性边缘的相关性，信息很少。本研究评估了 LLETZ 后边缘阳性与 CIN 存在的临床相关性。
在这项回顾性研究中，纳入了 2017 年 1 月至 2019 年 12 月期间在格罗宁根马蒂尼医院因宫颈发育不良而接受 LLETZ 的 567 名女性。主要结局是与切除边缘相关的宫颈发育不良（巴氏涂片≥2）的持续存在。进行了卡方检验，并报告了危险比和 95%置信区间（CI）。
中位随访 14 个月后，9%（N=28）有病变边缘和 4%（N=9）有清晰边缘的患者仍存在宫颈发育不良（P=0.044）。人乳头瘤病毒（HPV）阳性状态是一个独立的危险因素（危险比[HR]8.97，95%置信区间[CI]4.19-19.22）。有病变边缘和年龄较大的女性更不易出现清除 HPV（P<0.001）。
接受 LLETZ 治疗的宫颈发育不良患者显示出良好的长期结局，残留率较低。高危 HPV 结合切除边缘状态和年龄似乎是一种适当的风险分层，可能基于这些因素进行个体化管理。
