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Zhai F, Mu S, Song Y, Zhang M, Zhang C, Lv Z. Machine Learning Prediction of Residual and Recurrent High-Grade CIN Post-LEEP. Cancer Manag Res 2024; 16:1175-1187. [PMID: 39258245 PMCID: PMC11385362 DOI: 10.2147/cmar.s484057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/23/2024] [Indexed: 09/12/2024] Open
Abstract
Purpose This study aims to develop a machine learning (ML) model to predict the risk of residual or recurrent high-grade cervical intraepithelial neoplasia (CIN) after loop electrosurgical excision procedure (LEEP), addressing a critical gap in personalized follow-up care. Methods A retrospective analysis of 532 patients who underwent LEEP for high-grade CIN at Cangzhou Central Hospital (2016-2020) was conducted. In the final analysis, 99 women (18.6%) were found to have residual or recurrent high-grade CIN (CIN2 or worse) within five years of follow-up. Four feature selection methods identified significant predictors of residual or recurrent CIN. Eight ML algorithms were evaluated using performance metrics such as AUROC, accuracy, sensitivity, specificity, PPV, NPV, F1 score, calibration curve, and decision curve analysis. Fivefold cross-validation optimized and validated the model, and SHAP analysis assessed feature importance. Results The XGBoost algorithm demonstrated the highest predictive performance with the best AUROC. The optimized model included six key predictors: age, ThinPrep cytologic test (TCT) results, HPV classification, CIN severity, glandular involvement, and margin status. SHAP analysis identified CIN severity and margin status as the most influential predictors. An online prediction tool was developed for real-time risk assessment. Conclusion This ML-based predictive model for post-LEEP high-grade CIN provides a significant advancement in gynecologic oncology, enhancing personalized patient care and facilitating early intervention and informed clinical decision-making.
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Affiliation(s)
- Furui Zhai
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People's Republic of China
| | - Shanshan Mu
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People's Republic of China
| | - Yinghui Song
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People's Republic of China
| | - Min Zhang
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People's Republic of China
| | - Cui Zhang
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People's Republic of China
| | - Ze Lv
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People's Republic of China
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2
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Bruno MT, Panella MM, Valenti G, Di Grazia S, Sgalambro F, Farina J, Previti M, Mereu L. Vaginal Intraepithelial Neoplasia (VaIN) after Hysterectomy Is Strongly Associated with Persistent HR-HPV Infection. Cancers (Basel) 2024; 16:2524. [PMID: 39061164 PMCID: PMC11274675 DOI: 10.3390/cancers16142524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
The data from the literature show that women undergoing a LEEP due to CIN3 have a greater risk of having subsequent high-grade anogenital intraepithelial neoplasia or cancer, and the risk is greater for vaginal cancer than for anal and vulvar cancers. It is hypothesized that the laparoscopic hysterectomy procedure may cause a higher incidence of VaIN in hysterectomized women. There are few studies addressing this issue, and they show mixed results. This study aimed to investigate the incidence of high-grade or severe VaIN in the population of women undergoing hysterectomy for CIN3 or benign uterine disease and illustrate the treatment options and follow-up. METHODS This retrospective study was conducted on 170 women who underwent a laparoscopic hysterectomy due to high-grade cervical intraepithelial neoplasia (CIN3) or benign gynecological disease. The follow-up strategy included performing a cotest and colposcopy with biopsy if necessary. The median time between primary treatment and a diagnosis of high-grade VaIN was 18 months. RESULTS High-grade or severe VaIN was found in eight patients after hysterectomy (4.7%). All cases of high-grade VaIN occurred in women with persistent HPV infection. The most frequent genotype was 16. Women hysterectomized due to CIN3 showed an eight-fold greater risk than women hysterectomized due to benign disease of developing high-grade VaIN. The risk of VaIN is low in women hysterectomized due to benign disease. The risk of developing VaIN is greater in women with viral persistence. CONCLUSION All these elements suggest that it is a history of HPV-related disease of the lower genital tract and viral persistence, rather than hysterectomy itself, that should be considered risk factors for the development of high-grade VaIN. After hysterectomy, patients with a history of CIN should undergo annual screening with vaginal dome cytology and HPV testing.
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Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy;
| | - Marco Marzio Panella
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy;
| | - Gaetano Valenti
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy;
- Gynaecologic Oncology Unit, Humanitas Hospital, 95126 Catania, Italy
| | - Salvatore Di Grazia
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
| | - Francesco Sgalambro
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
| | - Jessica Farina
- Anatomic Pathology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Miriam Previti
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
| | - Liliana Mereu
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
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3
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Deng L, Wang T, Chen Y, Tang X, Xiang D. A predictive model for residual lesions after LEEP surgery in CIN III patients. Front Med (Lausanne) 2023; 10:1326833. [PMID: 38148909 PMCID: PMC10751019 DOI: 10.3389/fmed.2023.1326833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Background and aims The residual lesions after Loop Electrosurgical Excision Procedure (LEEP) contributes to poor prognosis in patients with Cervical Intraepithelial Neoplasia Grade 3 (CIN3). The aim of this study is to establish an effective clinical predictive model for residual lesions in CIN3 patients after LEEP. Methods A retrospective analysis was performed on 436 CIN3 patients who underwent total hysterectomy within 3 months after LEEP. Based on the post-hysterectomy pathologic, the patients were divided into the no residual group and residual group. Clinical parameters were compared between the two groups, and univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for residual lesions in CIN3 patients after LEEP. Using R software, a nomogram model was established and its effectiveness was evaluated using calibration plots. Results There were 178 cases in the residual group and 258 cases in the no residual group. The two groups had no significant difference in general characteristics (p > 0.05). It was found that Post-LEEP follow-up HPV, Post-LEEP follow-up TCT, and the Gland involvement were independent risk factors for residual lesions in CIN3 patients after LEEP (all p < 0.05). The consistency index (C-index) of the nomogram model for predicting residual lesions was 0.975 (0.962-0.988). Conclusion The Post-LEEP follow-up HPV, Post-LEEP follow-up TCT, and Gland involvement are independent risk factors related to residual tissue after LEEP surgery in CIN3 patients. The constructed nomogram can effectively predict the presence of residual tissue after LEEP surgery in CIN3 patients and has good practical value.
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Affiliation(s)
- Lihui Deng
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
| | - Tiejun Wang
- Department of Gynecological Oncology, Wuxi Maternal and Child Health Hospital, Wuxi, China
| | - Ye Chen
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
| | - Xueli Tang
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
| | - Dajun Xiang
- Department of Gynecology, Xishan People's Hospital of Wuxi City, Wuxi, China
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4
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Bruno MT, Bonanno G, Sgalambro F, Cavallaro A, Boemi S. Overexpression of E6/E7 mRNA HPV Is a Prognostic Biomarker for Residual Disease Progression in Women Undergoing LEEP for Cervical Intraepithelial Neoplasia 3. Cancers (Basel) 2023; 15:4203. [PMID: 37686479 PMCID: PMC10487243 DOI: 10.3390/cancers15174203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Teresa Bruno
- 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;
| | - Giulia Bonanno
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy;
| | - Francesco Sgalambro
- Obstetrics and Gynecology Unit, University Hospital “G. Rodolico”, 95100 Catania, Italy; (F.S.); (A.C.)
| | - Antonino Cavallaro
- Obstetrics and Gynecology Unit, University Hospital “G. Rodolico”, 95100 Catania, Italy; (F.S.); (A.C.)
| | - Sara Boemi
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95124 Catania, Italy;
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5
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Giannini A, Di Donato V, Sopracordevole F, Ciavattini A, Ghelardi A, Vizza E, D’Oria O, Simoncini T, Plotti F, Casarin J, Golia D’Augè T, Cuccu I, Serati M, Pinelli C, Bergamini A, Gardella B, Dell’Acqua A, Monti E, Vercellini P, D’Ippolito G, Aguzzoli L, Dario Mandato V, Giannella L, Scaffa C, Ditto A, Falcone F, Borghi C, Malzoni M, Di Giovanni A, Salerno MG, Liberale V, Contino B, Donfrancesco C, Desiato M, Perrone AM, De Iaco P, Ferrero S, Sarpietro G, Matarazzo MG, Cianci A, Cianci S, Bosio S, Ruisi S, Mosca L, Tinelli R, De Vincenzo R, Zannoni GF, Ferrandina G, Petrillo M, Capobianco G, Carlea A, Zullo F, Muschiato B, Palomba S, Greggi S, Spinillo A, Ghezzi F, Colacurci N, Angioli R, Benedetti Panici P, Muzii L, Scambia G, Raspagliesi F, Bogani G. Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization. Vaccines (Basel) 2023; 11:698. [PMID: 36992282 PMCID: PMC10051663 DOI: 10.3390/vaccines11030698] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
The objective of this work is to assess the 5-year outcomes of patients undergoing conization for high-grade cervical lesions that simultaneously present as risk factors in the persistence of HPV infection and the positivity of surgical resection margins. This is a retrospective study evaluating patients undergoing conization for high-grade cervical lesions. All patients included had both positive surgical margins and experienced HPV persistence at 6 months. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). The charts of 2966 patients undergoing conization were reviewed. Among the whole population, 163 (5.5%) patients met the inclusion criteria, being at high risk due to the presence of positive surgical margins and experiencing HPV persistence. Of 163 patients included, 17 (10.4%) patients developed a CIN2+ recurrence during the 5-year follow-up. Via univariate analyses, diagnosis of CIN3 instead of CIN2 (HR: 4.88 (95%CI: 1.10, 12.41); p = 0.035) and positive endocervical instead of ectocervical margins (HR: 6.44 (95%CI: 2.80, 9.65); p < 0.001) were associated with increased risk of persistence/recurrence. Via multivariate analyses, only positive endocervical instead of ectocervical margins (HR: 4.56 (95%CI: 1.23, 7.95); p = 0.021) were associated with worse outcomes. In this high-risk group, positive endocervical margins is the main risk factor predicting 5-year recurrence.
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Affiliation(s)
- Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.G.); (V.D.D.); (T.G.D.); (I.C.); (P.B.P.); (L.M.)
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.G.); (V.D.D.); (T.G.D.); (I.C.); (P.B.P.); (L.M.)
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Italy;
| | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60126 Ancona, Italy; (A.C.); (L.G.)
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, 54100 Massa, Italy;
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Ottavia D’Oria
- Department of Woman’s and Child’s Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (O.D.); (M.G.S.)
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.P.); (R.A.)
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, 21100 Varese, Italy; (J.C.)
| | - Tullio Golia D’Augè
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.G.); (V.D.D.); (T.G.D.); (I.C.); (P.B.P.); (L.M.)
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.G.); (V.D.D.); (T.G.D.); (I.C.); (P.B.P.); (L.M.)
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, 21100 Varese, Italy; (J.C.)
| | - Ciro Pinelli
- Ospedale di Circolo Fondazione Macchi, 21100 Varese, Italy (F.G.)
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, 20100 Milano, Italy;
| | - Barbara Gardella
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy; (B.G.); (A.S.)
| | - Andrea Dell’Acqua
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.D.); (E.M.); (P.V.)
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.D.); (E.M.); (P.V.)
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.D.); (E.M.); (P.V.)
| | - Giovanni D’Ippolito
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42019 Scandiano, Italy; (G.D.); (L.A.); (V.D.M.)
| | - Lorenzo Aguzzoli
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42019 Scandiano, Italy; (G.D.); (L.A.); (V.D.M.)
| | - Vincenzo Dario Mandato
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42019 Scandiano, Italy; (G.D.); (L.A.); (V.D.M.)
| | - Luca Giannella
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60126 Ancona, Italy; (A.C.); (L.G.)
| | - Cono Scaffa
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (C.S.); (F.F.); (S.G.)
| | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (A.D.); (F.R.)
| | - Francesca Falcone
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (C.S.); (F.F.); (S.G.)
| | - Chiara Borghi
- Department of Obstetrics and Gynecology, S. Anna University Hospital, 44121 Ferrara, Italy;
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, 83100 Avellino, Italy; (M.M.); (A.D.G.)
| | - Alessandra Di Giovanni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, 83100 Avellino, Italy; (M.M.); (A.D.G.)
| | - Maria Giovanna Salerno
- Department of Woman’s and Child’s Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (O.D.); (M.G.S.)
| | - Viola Liberale
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, 10144 Torino, Italy; (V.L.); (B.C.)
| | - Biagio Contino
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, 10144 Torino, Italy; (V.L.); (B.C.)
| | - Cristina Donfrancesco
- Department of Obstetrics and Gynecology, Azienda ASL Frosinone, Ospedale S Trinità di Sora, 03039 Sora, Italy; (C.D.); (M.D.)
| | - Michele Desiato
- Department of Obstetrics and Gynecology, Azienda ASL Frosinone, Ospedale S Trinità di Sora, 03039 Sora, Italy; (C.D.); (M.D.)
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (A.M.P.); (P.D.I.)
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (A.M.P.); (P.D.I.)
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, 16132 Genova, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.S.); (M.G.M.); (A.C.)
| | - Maria G. Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.S.); (M.G.M.); (A.C.)
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (G.S.); (M.G.M.); (A.C.)
| | - Stefano Cianci
- Department of Gynecologic Oncology, Università degli Studi di Messina, Policlinico G. Martino, 98122 Messina, Italy;
| | - Sara Bosio
- San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy; (S.B.); (S.R.)
| | - Simona Ruisi
- San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy; (S.B.); (S.R.)
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.M.); (N.C.)
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, “Valle d’Itria” Hospital, Martina Franca, Via San Francesco da Paola, 74015 Taranto, Italy;
| | - Rosa De Vincenzo
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (R.D.V.); (G.F.Z.); (G.F.); (G.S.)
| | - Gian Franco Zannoni
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (R.D.V.); (G.F.Z.); (G.F.); (G.S.)
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (R.D.V.); (G.F.Z.); (G.F.); (G.S.)
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.P.); (G.C.)
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.P.); (G.C.)
| | - Annunziata Carlea
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.Z.)
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.Z.)
| | | | - Stefano Palomba
- Unit of Obstetrics and Gynecology, GOM of Reggio Calabria & University ‘Magna Graecia’ of Catanzaro, 88100 Catanzaro, Italy;
| | - Stefano Greggi
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (C.S.); (F.F.); (S.G.)
| | - Arsenio Spinillo
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy; (B.G.); (A.S.)
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, 21100 Varese, Italy; (J.C.)
- Ospedale di Circolo Fondazione Macchi, 21100 Varese, Italy (F.G.)
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.M.); (N.C.)
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.P.); (R.A.)
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.G.); (V.D.D.); (T.G.D.); (I.C.); (P.B.P.); (L.M.)
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.G.); (V.D.D.); (T.G.D.); (I.C.); (P.B.P.); (L.M.)
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (R.D.V.); (G.F.Z.); (G.F.); (G.S.)
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (A.D.); (F.R.)
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (A.D.); (F.R.)
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Purut YE, Giray B, Akis S, Peker EK, Babayeva G, Kabaca C, Api M. Effect of Human Papillomavirus Subtype on the Rate of Positive Surgical Margin After Cervical Conization. Int J Surg Pathol 2023; 31:20-25. [PMID: 36514291 DOI: 10.1177/10668969221143460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective. Human papillomavirus (HPV) infection is a risk factor for cervical carcinoma. Over 100 types of HPV have been identified. The excisional procedures are recommended for women with high-grade cervical intraepithelial neoplasia. Surgical margin status is an important predictor of the risk of relapse. The aim of the current study was to evaluate whether HPV genotype is a predictive factor of positive surgical margin after cervical cone excision. Materials and Methods. The records of 448 HPV-infected patients who underwent loop electrosurgical excision or cold knife conization at a tertiary gynecological cancer center were retrospectively reviewed. The patients were divided into 6 groups according to HPV positivity: HPV 16 only, HPV 18 only, HPV 16/18, other high-risk HPV (hrHPV), HPV 16/hrHPV, and HPV 18/hrHPV. Results. There was no significant difference between the HPV groups in terms of age, parity, menopausal status, endocervical canal involvement, conization method, and the rates of positive margin (P = .15, P = .49, P = .07, P = .20, P = .24, P = .39, respectively). Conclusion. The results show that HPV subtypes might not be associated with endocervical canal involvement and the rates of positive margin. In addition, margin status was not related to the conization method and the number of excised cervical tissue.
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Affiliation(s)
- Yunus Emre Purut
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Burak Giray
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 145809Koc University School of Medicine, Istanbul, Turkey
| | - Serkan Akis
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Esra Keles Peker
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Gulchin Babayeva
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Canan Kabaca
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medipol University School of Medicine, Istanbul, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
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Zhu M, Yu M, Chen Z, Zhao W. Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy. Front Med (Lausanne) 2022; 9:807849. [PMID: 35295609 PMCID: PMC8918980 DOI: 10.3389/fmed.2022.807849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Currently, the commonly used surgical methods for cervical lesions include loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). However, the positive rate of surgical margins after LEEP is relatively high, which leads to disease recurrence and places further demand on clinical treatment. This study investigated factors related to positive margins after LEEP and established a scoring system to enhance preoperative risk assessment and surgical selection. Materials and Methods A retrospective analysis of the clinical data of 411 patients undergoing LEEP surgery for cervical lesions in the First Affiliated Hospital of University of Science and Technology of China (USTC), from January 2016 to March 2021, was performed. Cases were divided into a negative margin group (349 cases) and a positive margin group according to postoperative pathology. In the positive group (62 cases), single-factor and multi-factor analyses screened influencing factors; a logistic and additive scoring system was established; furthermore, a ROC curve was used to evaluate scoring effectiveness. Results The positive rate of resection margins after LEEP was 15.1%. Univariate analysis indicated a relationship to patient age, menopause, preoperative ThinPrep Cytology Test (TCT) results, lesion quadrant number under colposcopy, cervical biopsy, and the result of endocervical curettage (ECC). Multivariate analysis showed that age >35 y, menopause, preoperative TCT being high-grade squamous intraepithelial lesion (HSIL), four quadrants being involved under colposcopy, and ECC being HSIL were all independent influencing factors of positive margins after LEEP (P < 0.05). These were included with the above factors to establish a logistic and additive scoring system. When the logistic score was 17, the sensitivity and specificity of predicting positive margins after LEEP were 80.6 and 61.6%, respectively. When the additive score was 6, the sensitivity and specificity were 74.2 and 66.2%, respectively. Both scoring systems had good predictability (area under the curve AUC >0.75). Conclusions This study quantified factors influencing positive margins after LEEP and established a scoring system for evaluating patients before surgery to provide a basis for individualized treatment and selection of surgical methods.
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Affiliation(s)
- Meiling Zhu
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Mingyue Yu
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Zhengzheng Chen
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
- *Correspondence: Zhengzheng Chen
| | - Weidong Zhao
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
- Weidong Zhao
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Zang L, Huang J, Zhu J, Hu Y. Risk factors associated with the persistence of human papillomavirus after cervical excision in patients with high-grade squamous intra-epithelial neoplasia. Eur J Obstet Gynecol Reprod Biol 2021; 266:175-181. [PMID: 34689015 DOI: 10.1016/j.ejogrb.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/04/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate risk factors associated with the persistence of human papillomavirus (HPV) after cervical excision in patients with high-grade squamous intra-epithelial neoplasia (HSIL). METHODS A retrospective cohort study enrolled 550 patients who underwent cervical excision for HSIL between January 2015 and January 2018. The effects of various factors were assessed using univariate and multi-variate analyses. RESULTS The mean age of patients was 42.6 [standard deviation (SD) 8.7, range 22-64] years, and the mean duration of follow-up was 29.0 (SD 4.8, range 24-36) months. Persistent HPV infection after cone excision was detected in 78 (14.2%) patients. Univariate logistic regression analysis revealed that advanced age (>35 years), menopausal status, HPV type (HPV16/18), abnormal vaginal micro-ecological morphology, type of excision (loop electrosurgical excision procedure) and positive margin were closely associated with the persistence of HPV. Multi-variate analysis indicated that menopausal status [odds ratio (OR) 4.708, 95% confidence interval (CI) 2.770-8.001; p < 0.001], abnormal vaginal micro-ecological morphology (OR 2.320, 95% CI 1.372-3.922; p = 0.002) and positive margin (OR 3.346, 95% CI 1.261-8.876; p = 0.015) were significant risk factors for the persistence of HPV after treatment. Furthermore, infection with HPV16/18 increased the risk of persistent infection, and a higher rate of HPV persistence was found in patients who were infected with HPV18 (OR 1.020, 95% CI 0.415-2.505) or co-infected with HPV16/18 (OR 2.064, 95% CI 0.272-2.041) compared with HPV16. CONCLUSION Persistent HPV infection after surgical treatment for HSIL is considered to be strictly related to the recurrence and progression of disease. Patients who are at increased risk of HPV persistence should receive intensive follow-up after surgery, especially in the first year.
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Affiliation(s)
- Lejing Zang
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiahe Huang
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jufan Zhu
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Hu
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Zang L, Hu Y. Risk factors associated with HPV persistence after conization in high-grade squamous intraepithelial lesion. Arch Gynecol Obstet 2021; 304:1409-1416. [PMID: 34482445 DOI: 10.1007/s00404-021-06217-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Persistence of HPV infection in patients with high-grade squamous intraepithelial lesion (HSIL) undergoing cervical excision is considered strongly associated with the recurrence and progression of cervical dysplasia. This study aims to review potential risk factors for persistence of HPV infection in patients with HSIL, thus optimizing the postoperative monitoring program and clinical treatment. METHODS Through literature review, published data about estimated prognostic risk factors for persistence of HPV infection in patients with HSIL after conization within two decades were searched and analyzed, and their references were manually reviewed as well. RESULTS Women with persistence of HPV infection after cervical excision were at an extremely high risk of disease recurrence and progression to cervical cancer. Some clinicopathological and even physiological elements involving viral, organic human body and treatment factors, such as human papillomavirus (HPV) 16, high viral load, age older than 50 years and positive surgical margin were of prognostic significance in persistent HPV infection in patients with HSIL, yet some of which still remained controversial. CONCLUSIONS Monitoring prognostic factors in women with persistence of HPV infection who have underwent cervical excision for HSIL are of great significance, especially the follow-up within 2 years postoperatively, which significantly improves the clinical outcome.
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Affiliation(s)
- Lejing Zang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang Province, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, 325000, Zhejiang Province, China.
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Ge Y, Liu Y, Cheng Y, Liu Y. Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization. Medicine (Baltimore) 2021; 100:e26359. [PMID: 34232170 PMCID: PMC8270570 DOI: 10.1097/md.0000000000026359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization.Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data.After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases (P < .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317-3.492, P < .05), history of preterm birth (HR = 4.515, 95% CI: 1.598-12.754, P < .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952-6.462, P < .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth >0.5 cm was a protective factor for postoperative recurrence.For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (>0.5 cm) with lower risk of recurrence.
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Affiliation(s)
- Yan Ge
- Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China
| | - Yongli Liu
- Department of Gynecology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou No.1 People's Hospital, Xuzhou, P.R. China
| | - Yun Cheng
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yanbo Liu
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
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Abdulaziz AM, You X, Liu L, Sun Y, Zhang J, Sun S, Li X, Sun W, Dong Y, Liu H, Zhang Y. Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization: A retrospective study. Medicine (Baltimore) 2021; 100:e26030. [PMID: 34011112 PMCID: PMC8137043 DOI: 10.1097/md.0000000000026030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
To explore the optimal way to manage patients with high-grade squamous intraepithelial lesion (HSIL) and positive margin by identifying the risk factors for its recurrence and residue.A retrospective study was conducted on 267 cases of a pathologically confirmed HSIL with positive margin following conization by loop electrosurgical excisional procedure (LEEP) between January 2010 and December 2015. One hundred two cases were selected for regular follow-up every 6 months, and 165 cases were selected for a second surgery (repeat cervical conization or hysterectomy) within 3 months of initial LEEP. We analyzed the association between recurrent or residual diseases and these factors: age, menopausal status, ThinPrep cytologic test (TCT) results, high-risk human papillomavirus (HR-HPV) infection, pathological grades of the margin, number of involved margins, and glandular involvement.The recurrence rate among 102 cases who underwent follow-up was 17.6% (18/102). The factors: atypical squamous cells of undetermined significance cannot exclude HSIL (ASC-H) or higher lesions in the pre-LEEP TCT (P = .038), persistent HR-HPV infection at the 6th month post-LEEP (P = .03), HSIL-positive margin (P = .003), and multifocal-involved margin (P = .002) were significantly associated with recurrent disease, while age, menopause, and pre-LEEP HR-HPV infection were not associated with recurrent disease (P > .05). The residual rate among 165 patients who underwent a second surgery was 45.5% (75/165), of which 15 cases were residual cervical cancer. The factors: menopause (P = .02), ≥ASC-H in pre-LEEP TCT (P = .04), pre-LEEP HR-HPV infection (P = .04), ≥HSIL-positive margin (P < .001), and multifocal-involved margin (P < .001) significantly increased the risk of residual disease. No correlation existed between residual disease and age or glandular involvement (P > .05).For patients with a positive margin after LEEP, regular follow-up or second surgery should be selected according to fertility requirement and pathological characteristics of the positive margin, as well as TCT and HR-HPV infection condition.
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12
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Sun X, Lei H, Xie X, Ruan G, An J, Sun P. <p>Risk Factors for Residual Disease in Hysterectomy Specimens After Conization in Post-Menopausal Patients with Cervical Intraepithelial Neoplasia Grade 3</p>. Int J Gen Med 2020; 13:1067-1074. [PMID: 33204141 PMCID: PMC7667014 DOI: 10.2147/ijgm.s280576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
Background Post-menopausal patients with cervical intraepithelial neoplasia (CIN) have a high rate of residual or recurrent lesions after treatment, and their risk for cervical cancer later in life is higher than the general population. Hence, management for this specific group of post-menopausal patients needs more attention. Objective The study aimed to identify risk factors associated with the presence of residual disease in hysterectomy specimens in post-menopausal patients with cervical intraepithelial neoplasia grade 3 (CIN 3). Methods This study was a retrospective analysis of data from post-menopausal women who had undergone hysterectomy following conization for CIN 3 from 2012 to 2018 at Fujian Maternity and Child Health Hospital. Factors extracted from the database included age, parity, Thinprep cytology results, human papillomavirus (HPV) genotype, biopsy results, pre-cone endocervical curettage (ECC) results, conization method, operating surgeon, cone dimension, margin status and glandular involvement. Univariate and multivariate analyses were performed to identify risk factors associated with residual disease in hysterectomy specimens. Results Analysis of data from 129 women was performed. The proportion of residual disease was 43.41% overall. A higher grade according to colposcopy biopsy, abnormal pre-cone ECC results, the cone method (LEEP vs CKC), a cone volume >1.57 cm3, and positive margins in conization specimens were found to be significantly associated with residual lesions on univariable analysis. After multivariate analysis, only an abnormal pre-cone ECC result (odds ratio 3.99; 95% confidence interval (CI) 1.41–11.33; p = 0.009) remained significant. Conclusion The rate of residual lesions in uterine specimens was high regardless of the cone margin status in post-menopausal women with CIN 3. Risk-based strategies are needed to identify patients who have abnormal pre-cone ECC results, and definitive treatment with hysterectomy should be considered in post-menopausal patients with an elevated risk for residual lesions.
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Affiliation(s)
- Xiaoqi Sun
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
| | - Huifang Lei
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
| | - Xiaoyan Xie
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
| | - Guanyu Ruan
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
| | - Jian An
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
- Correspondence: Jian An; Pengming Sun Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Fuzhou, Fujian350001, People’s Republic of China Email ;
| | - Pengming Sun
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian350001, People’s Republic of China
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Spinillo A, Dominoni M, Boschi AC, Cesari S, Fiandrino G, Gardella B. The relationship of human papillomavirus infection with endocervical glandular involvement on cone specimens in women with cervical intraepithelial neoplasia. Gynecol Oncol 2020; 159:630-635. [PMID: 33041069 DOI: 10.1016/j.ygyno.2020.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of study was to evaluate the association of endocervical gland involvement (EGI) on histological samples with high risk (HR) human papillomavirus (HPV) infection and with the persistence/recurrence rate of cervical intraepithelial neoplasia (CIN) after treatment. METHODS A total of 1301 subjects who had conization procedures after cervical punch biopsies (533 persistent CIN1, 768 CIN2+ including 20 microinvasive cervical cancer) were enrolled in the study. HPV genotypes were identified using the INNO-LiPA HPV genotyping assay on cervical scraping. Logistic regression and Cox regression analyses were used to evaluate the association of EGI on the persistence/recurrence rate of CIN after treatment. RESULTS The rate of EGI on final histology was 46.3% (602/1301). HPV 16 was the only HR-HPV significantly associated with increasing rates of EGI (231/602 as compared to 211/699, p = 0.002). EGI was also associated with an excess of multiple HR-HPV infections (237/602 as compared with 225/699, p = 0.006). After correction for confounders, the odds ratio of EGI among women infected by HPV 16 was 1.41 (95% CI = 1.12-178). CIN2+ lesions were diagnosed in 40.5% (283/699) of EGI negative subjects and 86.7% (522/602, p < 0.001 compared to negative subjects) of EGI positive subjects.After a median of 25 months of follow-up (IQR = 15-47) of 1090 treated women, the persistence of HPV 16 during follow-up was 38.1% (93/217, p = 0.03 compared to EGI negative) among EGI positive and 32% (58/181) among controls. After corrections for potential confounders, the odds ratio of CIN2+ persistence and or recurrence was higher among EGI positive (OR = 2.35, 95% CI = 1.16-4.77) than negative controls. CONCLUSION EGI on histological samples is associated with increased rates of HPV 16, multiple high risk-HPV infections and CIN2+ lesions. EGI positive subjects also had an increased CIN recurrence/persistence after treatment compared to controls.
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Affiliation(s)
- Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Anna Chiara Boschi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Stefania Cesari
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Università of Pavia, Italy
| | - Giacomo Fiandrino
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Università of Pavia, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.
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Lee CY, Chen YL, Chiang YC, Cheng CY, Lai YL, Tai YJ, Hsu HC, Hwa HL, Cheng WF. Outcome and Subsequent Pregnancy after Fertility-Sparing Surgery of Early-Stage Cervical Cancers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7103. [PMID: 32998288 PMCID: PMC7579067 DOI: 10.3390/ijerph17197103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 12/26/2022]
Abstract
We aimed to investigate the outcomes and subsequent pregnancies of early-stage cervical cancer patients who received conservative fertility-sparing surgery. Women with early-stage cervical cancer who underwent conservative or fertility-sparing surgery in a tertiary medical center were reviewed from 2004 to 2017. Each patient's clinicopathologic characteristics, adjuvant therapy, subsequent pregnancy, and outcome were recorded. There were 32 women recruited, including 12 stage IA1 patients and 20 stage IB1 patients. Twenty-two patients received conization/LEEP and the other 10 patients received radical trachelectomy. Two patients did not complete the definite treatment after fertility-sparing surgery. There were 11 women who had subsequent pregnancies and nine had at least one live birth. The live birth rate was 73.3% (11/15). We conclude that patients with early-stage cervical cancer who undergo fertility-sparing surgery can have a successful pregnancy and delivery. However, patients must receive a detailed consultation before surgery and undergo definitive treatment, if indicated, and regular postoperative surveillance.
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Affiliation(s)
- Chia-Yi Lee
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Yun-Lin Branch, Douliou City 640, Yunlin County, Taiwan
| | - Ching-Yu Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
| | - Yen-Ling Lai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City 300, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City 300, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Hsiao-Lin Hwa
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
- Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-Y.L.); (Y.-L.C.); (Y.-C.C.); (C.-Y.C.); (Y.-L.L.); (Y.-J.T.); (H.-C.H.); (H.-L.H.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
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The effects of different instruments and suture methods of conization for cervical lesions. Sci Rep 2019; 9:19114. [PMID: 31836814 PMCID: PMC6910914 DOI: 10.1038/s41598-019-55786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022] Open
Abstract
This study is to compare the surgical outcomes of patients undergoing cold knife conization (CKC) versus electrosurgical conization (ESC). Among 10,086 patients in a single center admitted between January 2000 and January 2019, CKS or ESC was used for grade 3 cervical intraepithelial neoplasia (CIN3) or more severe lesions. Modified Sturmdorf or Figure-of-eight sutures were applied after conization. A regression model was used to determine the risk factors for margin involvement and short-term post-operative complications. In total, 7275 (72.1%) and 2811 (27.9%) patients underwent CKC and ESC, respectively. Women who underwent ESC were older and had a higher risk of margin involvement and endocervical glandular involvement than those who underwent CKC in univariate analysis. However, in the multivariate analysis, age (odds ratio [OR] 1.032, 95% confidence interval [95% CI] 1.025–1.038) and glandular involvement (OR 2.196, 95% CI 1.915–2.517) were the independent risk factors associated with margin involvement, but the incision methods used caused no significant difference. Modified Sturmdorf sutures and Figure-of-eight sutures were applied in 3520 (34.9%) and 6566 (65.1%) patients, respectively. The modified Sturmdorf sutures was the only risk factor associated with wound hemorrhage (OR 1.852, 95% CI 1.111–3.085) after adjusted with other epidemiological and surgical factors. Various incision or suture methods had similar risk of cervical stenosis. Therefore, ESC is an acceptable alternative to CKC for the diagnosis and treatment of cervical lesions regarding the pathologic accuracy and integrity, and short-term safety. Modified Sturmdorf sutures increased the risk of wound hemorrhage compared with Figure-of-eight sutures.
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What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status? Eur J Obstet Gynecol Reprod Biol 2019; 244:180-184. [PMID: 31812841 DOI: 10.1016/j.ejogrb.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies have shown associations between independent pre-conization variables (e.g. smoking, age, cytological grade, menopause) and positive or negative cone margins. However, it is not clear if these pre-surgical variables add predictive value to cone dimensions in the prediction of cone margin status. This study aimed to compare different models predicting positive ecto- or endocervical margins to assess whether pre-conization variables provide significant added value compared with cone dimensions alone. STUDY DESIGN One hundred and sixty-one consecutive women with high-grade cervical intra-epithelial neoplasia on cone specimens were analysed retrospectively. The sample was divided into women with positive ecto- or endocervical cone margins and women with negative ecto- or endocervical cone margins. Pre-conization clinical features, cone volume and cone length were included among the study variables. Multivariate stepwise regression analysis was used to create different models predicting incomplete cervical excision. The added value of pre-conization predictors was measured with receiver operating characteristic (ROC) curve comparisons. RESULTS Fifty-seven (35.4 %) women had incomplete cervical excision. Multivariate analysis showed that a positive ectocervical margin was significantly associated with low-grade cervical cytology [odds ratio (OR) = 0.25, 95 % confidence interval (CI) 0.09-0.70] and cone length (OR = 0.69, 95 % CI 0.58-0.82, criterion <9 mm). The area under the curve (AUC) of the combined model for prediction of a positive ectocervical margin was 0.78 (95 % CI 0.70-0.84, p < 0.001). A positive endocervical margin was associated with cone length (OR=0.78, 95 % CI 0.65-0.93, criterion <9 mm) and age (OR=1.07, 95 % CI 1.02-1.11, criterion ≥45 years). The AUC of the combined model for prediction of positive endocervical margin was 0.75 (95 % CI 0.66-0.82, p < 0.001). Comparison of ROC curves showed that the addition of pre-conization variables to cone length did not yield significant predictive results for either ecto- or endocervical cone margins (p = 0.228 and 0.349, respectively). CONCLUSIONS The addition of pre-conization clinical variables to cone dimensions did not improve the prediction of cone margin status significantly in the study cohort. Among cone dimensions, cone length was the best predictor of come margin status.
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Giray B, Kabaca-Kocakusak C, Guray-Uzun M, Akis S. Post-conization follow-up of patients with CIN 2/3 with different amount of distance to negative cone biopsy margin: a retrospective cohort study. J OBSTET GYNAECOL 2019; 40:406-410. [PMID: 31455147 DOI: 10.1080/01443615.2019.1633517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate whether patients with CIN 2/3 with different amount of distance to negative cone biopsy margin differ in terms of post-conization follow-up results. Cold-knife cone specimens with a negative surgical margin with a diagnosis of CIN-2/3 were selected. The minimum distance between the margin and lesion was categorised as less than 2 mm (Group-1), 2-5 mm (Group-2), or more than 5 mm (Group-3). There were no statistically significant differences between groups in terms of postoperative cone-biopsy results (p = .61). Furthermore, there were no statistically significant differences between groups in terms of cytology at 6 months and 12 months (p = .33 and p = .80, respectively). Results of the present study indicate that the amount of distance of lesion to cone biopsy margin seems to have no effect on follow-up results in patients with negative surgical margin.Impact StatementWhat is already known on this subject? Negative surgical margins on conization are associated with lower rates of lesion recurrence. Only the efficacy of volume and size of cone biopsy specimens have been analysed on lesion recurrence. However, there is no clear definition of the minimum distance of a negative margin during cone biopsy.What do the results of this study add? To the best of our knowledge, this is the first study describing the post-conization follow-up of patients with CIN 2/3 with different amount of distance to negative cone biopsy margin. Patients who underwent surgical treatment with a wider cone biopsy margin and narrower cone biopsy margin demonstrated similar follow-up results.What are the implications of these findings for clinical practice and/or further research? The present study provides valuable information to guide physicians performing conizations with an appropriate amount of negative surgical margin. Future studies investigating the effect of different amount of distance to negative cone biopsy margin on gynaecologic and obstetrics complications such as stenosis, bleeding, and preterm labour, low birth weight, and perinatal mortality are needed to show the benefits of a narrower distance to negative cone biopsy margin.
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Affiliation(s)
- Burak Giray
- Department of Gynecologic Oncology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Canan Kabaca-Kocakusak
- Department of Gynecologic Oncology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Mine Guray-Uzun
- Department of Gynecologic Oncology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Serkan Akis
- Department of Gynecologic Oncology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins. PLoS One 2019; 14:e0217562. [PMID: 31163055 PMCID: PMC6548378 DOI: 10.1371/journal.pone.0217562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We aimed to determine demographic and clinicopathological predictors for residual disease in women with cervical intraepithelial neoplasia (CIN 2/3) with endocervical cone margin involvement. METHODS AND FINDINGS A cross-sectional study was conducted. The eligible patients were women who underwent hysterectomy as a treatment option after having a positive endocervical margin for CIN 2/3 in cervix conization specimens from 2000 to 2015. The patients were divided into two groups based on the persistence of CIN 2/3 and absence of CIN 2/3 in hysterectomy specimens. Demographic, clinical and histology information were collected in both groups. A total of 80 patients were eligible for the study; 37 (46.3%) had no persistence of CIN 2/3 and 43 (53.7%) had persistence of CIN 2/3 in the hysterectomy specimens. Demographic, clinical, and cone specimen characteristics, and a visible squamocolumnar junction and type of conization were analyzed as possible risk factors for the presence of residual lesions at hysterectomy, and none of these variables were associated with residual disease. Menopausal status was strongly associated with a high risk of persistent residual disease 81.2% (OR 4.9, CI 1.27-18.9), P = 0.014. In the multivariate analysis, only a menopausal status (P = 0.04) was associated with a high risk of persistent lesions. CONCLUSION This analysis found that menopausal status exhibited an important association with persistent residual disease. Menopausal women with endocervical margin involvement exhibit a greater than 80% risk of persistent lesions.
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Yingyongwatthanawitthaya T, Chirdchim W, Thamrongwuttikul C, Sananpanichkul P. Risk Factors for Incomplete Excision after Loop Electrosurgical Excision Procedure (LEEP) in Abnormal Cervical Cytology. Asian Pac J Cancer Prev 2017; 18:2569-2572. [PMID: 28952302 PMCID: PMC5720668 DOI: 10.22034/apjcp.2017.18.9.2569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To investigate the risk factors related to incomplete excision after loop electrosurgical excision procedure (LEEP) in abnormal cervical cytology. Methods: This retrospective cohort study was performed during September 2010 to February 2017. The study population was patients with abnormal cervical cytology who treated by LEEP at Prapokklao hospital, Chanthaburi. From the medical records, data were collected include age, menopausal status, parity, body mass index, HIV infection, history of smoking, cervical cytology and characteristics of LEEP histopathology such as number of specimen, size and glandular involvement. Risk factors were investigated using multivariable risk ratio from risk ratio regression. Result: Five hundred cases of LEEP were done during this period and 322 cases were analyzed. Complete excision of the LEEP specimens found nearly half of the cases (46.9%). Multiple pieces of specimen was the risk factor for incomplete excision of LEEP (adjusted risk ratio [aRR] = 1.29, 95% confidence interval [CI] = 1.06-1.58; P = 0.013). Conclusion: The number of specimen from LEEP more than one piece was the risk factor for incomplete excision. Alternative methods such as cold knife conization (CKC), needle excision of the transformation zone (NETZ) or contoured loop excision of the transformation zone (C-LETZ) should be justified when all lesions could not be operated by single sweep.
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Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization: a retrospective analysis. Front Med 2017; 11:223-228. [DOI: 10.1007/s11684-017-0517-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/23/2017] [Indexed: 12/29/2022]
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