Paternostro Chiara, Joura Elmar A, Ranftl Christina, Langthaler Eva-Maria, Ristl Robin, Dorittke Tim, Pils Sophie
Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria.
Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria.
Life (Basel). 2023 Aug 20;13(8):1775. doi: 10.3390/life13081775.
The aim of this study was to evaluate the endocervical margin status according to transformation zone (TZ) and high-risk HPV (hr-HPV) subtype in specimens with cone length ≤ 10 mm versus > 10 mm to provide data for informed decision making and patients counseling especially for women wishing to conceive. In this retrospective cohort study, 854 patients who underwent large loop excision of the transformation zone during a nine-year period (2013-2021) for cervical disease were analyzed. The main outcome parameters were excision length, histological result, TZ type, HPV subtype and endocervical margin status. A subgroup analysis was performed according to excision length, with a cut-off value of 10 mm. A two-step surgical procedure was performed in case of an excision length of > 10 mm. The overall rate of positive endocervical margins irrespective of excision length was 17.2%, with 19.3% in specimens with ≤ 10 mm and 15.0% with > 10 mm excision length. Overall, 41.2% of women with a visible TZ and HPV 16/hr infection and 27.0% of women with HPV 18 received an excisional treatment of > 10 mm length without further oncological benefit, respectively. In contrast, assuming that only an excision of ≤ 10 mm length had been performed in women with visible TZ, the rate of clear endocervical margins would have been 63.7% for HPV 16/hr infections and 49.3% for HPV 18 infections. In conclusion, the decision about excision length should be discussed with the patient in terms of oncological safety and the risk of adverse pregnancy events. An excision length > 10 mm increases the number of cases with cervical tissue removed without further oncological benefit, which needs to be taken into account in order to provide an individual therapeutic approach. Furthermore, HPV 18 positivity is related to a higher rate of positive endocervical margins irrespective of TZ.
本研究的目的是评估在锥切长度≤10mm与>10mm的标本中，根据转化区（TZ）和高危型人乳头瘤病毒（hr-HPV）亚型的宫颈管切缘状态，为明智的决策制定和患者咨询提供数据，特别是对于希望怀孕的女性。在这项回顾性队列研究中，分析了854例在9年期间（2013 - 2021年）因宫颈疾病接受转化区大环形切除术的患者。主要结局参数为切除长度、组织学结果、TZ类型、HPV亚型和宫颈管切缘状态。根据切除长度进行亚组分析，临界值为10mm。切除长度>10mm时采用两步手术程序。无论切除长度如何，宫颈管切缘阳性的总体发生率为17.2%，切除长度≤10mm的标本中为19.3%，切除长度>10mm的标本中为15.0%。总体而言，可见TZ且感染HPV 16/hr的女性中有41.2%以及感染HPV 18的女性中有27.0%接受了长度>10mm的切除治疗，但未获得进一步的肿瘤学益处。相比之下，假设在可见TZ的女性中仅进行了长度≤10mm的切除，HPV 16/hr感染的宫颈管切缘阴性率将为63.7%，HPV 18感染的为49.3%。总之，应就肿瘤学安全性和不良妊娠事件的风险与患者讨论切除长度的决策。切除长度>10mm会增加切除宫颈组织但未获得进一步肿瘤学益处的病例数量，为提供个体化治疗方法需要考虑这一点。此外，无论TZ如何，HPV 18阳性与宫颈管切缘阳性率较高相关。
