Bruno Maria Teresa, Bonanno Giulia, Sgalambro Francesco, Cavallaro Antonino, Boemi Sara
Department of General Surgical and Medical-Surgery Specialities, University of Catania, 95124 Catania, Italy.
Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95124 Catania, Italy.
Cancers (Basel). 2023 Aug 22;15(17):4203. doi: 10.3390/cancers15174203.
The risk of overtreatment or not treating an occult carcinoma exists in women at risk of residual disease after a LEEP excision for CIN3. Our goal was to discover an efficient method to select patients requiring a second LEEP from those requiring a FU only through an mRNA-detection test. In a population of 686 women undergoing a LEEP excision for CIN 3, we selected 285 women at risk of residual disease and subjected them to a search for E6/E7 mRNA HPV. The women with negative mRNA were subjected to a follow up, while the women with positive mRNA were subjected to a second LEEP. The histological examination of the second cone revealed 120 (85.7%) cases of residual disease in the mRNA-positive women: 40 cases of CIN2, 51 cases of CIN3, 11 cases of squamous microinvasive carcinoma, 7 cases of squamous carcinoma, 9 cases of AIS (adenocarcinoma in situ) and 2 cases of adenocarcinoma. Among the mRNA-negative women undergoing a follow up, there were only five cases of residual disease. During the follow-up period of about 6 years, we witnessed the regression of the residual disease and the elimination of the virus, just as predicted by the negative result of the mRNA test. Testing patients for E6/E7 mRNA allowed us to identify women with residual disease (CIN2+) and treat them appropriately.
对于因CIN3接受LEEP切除术后有残留疾病风险的女性,存在过度治疗或未治疗隐匿性癌的风险。我们的目标是通过mRNA检测试验,找到一种有效的方法,从仅需要随访的患者中筛选出需要再次进行LEEP的患者。在686名因CIN 3接受LEEP切除的女性群体中,我们选择了285名有残留疾病风险的女性,并对她们进行E6/E7 mRNA HPV检测。mRNA检测结果为阴性的女性接受随访,而mRNA检测结果为阳性的女性则接受再次LEEP。对第二次锥切组织进行病理检查发现,mRNA检测结果为阳性的女性中有120例(85.7%)存在残留疾病:40例CIN2、51例CIN3、11例鳞状微浸润癌、7例鳞状细胞癌、9例原位腺癌(AIS)和2例腺癌。在接受随访的mRNA检测结果为阴性的女性中,只有5例存在残留疾病。在大约6年的随访期内,正如mRNA检测阴性结果所预测的那样,我们观察到残留疾病消退且病毒清除。对患者进行E6/E7 mRNA检测使我们能够识别出有残留疾病(CIN2+)的女性并对她们进行适当治疗。