Bruno Maria Teresa, Cavallaro Antonino Giovanni, Fiore Maria, Ruggeri Zaira, Somma Martina, Pagana Alessia, Mascellino Giuseppe, Laganà Antonio Simone
Department of General Surgery and Medical Surgery Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy.
Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
Cancers (Basel). 2025 Jul 7;17(13):2264. doi: 10.3390/cancers17132264.
In postmenopausal women with high-grade cervical intraepithelial neoplasia (CIN3), hysterectomy is frequently performed after loop electrosurgical excision procedure (LEEP) due to the concern for residual disease or occult carcinoma. However, the decision to proceed with hysterectomy is often made without validated predictive criteria, increasing the risk of overtreatment or underdiagnosis. The aim of this study is to identify independent predictors of residual CIN2+ (CIN2, CIN3, adenocarcinoma in situ, invasive carcinoma) or invasive disease in hysterectomy specimens following LEEP in this high-risk population.
We conducted a multicenter retrospective study including 154 postmenopausal women (aged 50-75) who underwent total hysterectomy within 12 months after LEEP for histologically confirmed CIN3. Data collected included human papillomavirus (HPV) genotyping (pre- and post-LEEP), endocervical curettage (ECC), cone margin status, transformation zone type, and histopathological outcomes of the hysterectomy specimen. Logistic regression and ROC curve analysis were used to assess predictive factors.
Residual disease (CIN2+, AIS, or carcinoma) was found in 38 patients (24.7%), including 7 cases (4.5%) of occult carcinoma. Persistent high-risk HPV post-LEEP was the strongest independent predictor (adjusted OR for HPV 16/18: 74.0; < 0.001), followed by positive ECC (OR: 3.64; = 0.028). Cone margin status was not independently associated. The multivariate model showed good discriminative performance (AUC = 0.860; sensitivity 67.2%, specificity 72.8%).
Our findings suggest that persistent high-risk HPV infection and positive ECC are reliable predictors of residual or occult disease. These markers should be integrated into post-LEEP follow-up protocols to better identify candidates for hysterectomy and minimize unnecessary surgeries.
在绝经后患有高级别宫颈上皮内瘤变（CIN3）的女性中，由于担心残留疾病或隐匿性癌，环形电切术（LEEP）后常进行子宫切除术。然而，进行子宫切除术的决定往往是在没有经过验证的预测标准的情况下做出的，这增加了过度治疗或诊断不足的风险。本研究的目的是确定在这一高危人群中，LEEP术后子宫切除标本中残留CIN2+（CIN2、CIN3、原位腺癌、浸润癌）或浸润性疾病的独立预测因素。
我们进行了一项多中心回顾性研究，纳入了154名绝经后女性（年龄50 - 75岁），她们在LEEP术后12个月内接受了全子宫切除术，组织学确诊为CIN3。收集的数据包括人乳头瘤病毒（HPV）基因分型（LEEP术前和术后）、宫颈管搔刮术（ECC）、锥切边缘状态、转化区类型以及子宫切除标本的组织病理学结果。采用逻辑回归和ROC曲线分析来评估预测因素。
38例患者（24.7%）发现残留疾病（CIN2+、原位腺癌或癌），其中7例（4.5%）为隐匿性癌。LEEP术后持续高危HPV感染是最强的独立预测因素（HPV 16/18调整后的OR值：74.0；<0.001），其次是ECC阳性（OR值：3.64；=0.028）。锥切边缘状态无独立相关性。多变量模型显示出良好的鉴别性能（AUC = 0.860；敏感性67.2%，特异性72.8%）。
我们的研究结果表明，持续高危HPV感染和ECC阳性是残留或隐匿性疾病的可靠预测因素。这些标志物应纳入LEEP术后随访方案，以更好地识别子宫切除术的候选者并尽量减少不必要的手术。
Zotero 插件