Universidade de Campinas Department of Obstetrics and Gynecology CampinasSP Brazil Department of Obstetrics and Gynecology, Universidade de Campinas, Campinas, SP, Brazil.
Universidade de Santo Amaro Medicine School São PauloSP Brazil Medicine School, Universidade de Santo Amaro, São Paulo, SP, Brazil.
Rev Bras Ginecol Obstet. 2024 May 27;46. doi: 10.61622/rbgo/2024rbgo44. eCollection 2024.
To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil.
A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression.
The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative.
The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.
描述巴西一家转诊医院中盖帽（Top-hat）的结果及其与边缘状态和疾病复发的关系。
这是一项回顾性研究，纳入了 440 名因 HSIL 接受 LEEP 治疗的女性，其中 80 例立即行盖帽术（盖帽组，TH 组）。TH 组与未行盖帽术的女性（未盖帽组，NTH 组）进行比较。通过方便抽样，样本包括 2017 年 1 月至 2020 年 7 月期间接受 LEEP 的所有女性。主要结局为组织学结果。其他变量为边缘状态、年龄、转化区（TZ）、深度和复发。采用卡方检验和 logistic 回归进行分析。
TH 组主要为 40 岁及以上的女性（NTH 组 23.1%，TH 组 65.0%，p<0.001）。最终诊断为 CIN2/CIN3 的比例无差异（NTH 组 17.0%，TH 组 21.3%，p=0.362），复发率也无差异（NTH 组 12.0%，TH 组 9.0%，p=0.482）。80 例行盖帽术的患者中，8 例组织学结果为 CIN2/CIN3。阴性的盖帽结果与阴性的宫颈内口边缘相关，其阳性预测值为 83.3%。CIN2/CIN3 的盖帽结果与 CIN2/CIN3 的边缘状态相关，阳性预测值为 62.5%（p=0.009）。当宫颈内口边缘阴性时，获得阴性盖帽结果的机会增加 22.4 倍（2.4-211.0），当宫颈外口边缘阴性时，获得阴性盖帽结果的机会增加 14.5 倍（1.5-140.7）。
盖帽术并未改变 LEEP 的最终诊断。未观察到对复发的影响。该术式应避免用于有生育需求的女性。
