Analysis of outcomes following loop electrosurgical excision and clinical features of patients with cervical high-grade squamous intraepithelial lesions with abnormal preoperative endocervical curettage

Feng, C.; Gu, Liyi; Wei, Yingting; Niu, Jiaxin; Yang, Haima; Hong, Zubei; Qiu, Lihua

doi:10.1186/s12957-023-03088-5

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Feng's study showed that the detection rate of HSIL increased by 5% in patients who underwent colposcopy combined with ECC [37], and this detection rate increased with age [38]. At the same time, Feng's study confirmed that 2 years after the LEEP, the rate of recurrence in patients with ECC positivity was as high as 15.9% [37]. Our study revealed that ECC suggesting HSIL was an independent risk factor for uterine residual lesions.…”

Section: Discussionsupporting

confidence: 63%

“…According to current when colposcopy is inadequate, ECC can be considered for nonpregnant patients [36]. Feng's study showed that the detection rate of HSIL increased by 5% in patients who underwent colposcopy combined with ECC [37], and this detection rate increased with age [38]. At the same time, Feng's study confirmed that 2 years after the LEEP, the rate of recurrence in patients with ECC positivity was as high as 15.9% [37].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

Wang,

2024

BMC Women's Health

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Background The purpose of this study was to predict the risk factors for residual lesions in patients with high-grade cervical intraepithelial neoplasia who underwent total hysterectomy. Methods This retrospective study included 212 patients with histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2-3) who underwent hysterectomy within 6 months after loop electrosurgical excision procedure (LEEP). Clinical data (e.g., age, menopausal status, HPV type, and Liquid-based cytology test(LCT) type), as well as pathological data affiliated with endocervical curettage (ECC), colposcopy, LEEP and hysterectomy, were retrieved from medical records. A logistic regression model was applied to estimate the relationship between the variables and risk of residual lesions after hysterectomy. Results Overall, 75 (35.4%) patients had residual lesions after hysterectomy. Univariate analyses revealed that positive margin (p = 0.003), glandular involvement (p = 0.017), positive ECC (p < 0.01), HPV16/18 infection (p = 0.032) and vaginal intraepithelial neoplasia (VaIN) I-III (p = 0.014) were factors related to the presence of residual lesions after hysterectomy. Conversely, postmenopausal status, age ≥ 50 years, ≤ 30 days from LEEP to hysterectomy, and LCT type were not risk factors for residual lesions. A positive margin (p = 0.025) and positive ECC (HSIL) (p < 0.001) were identified as independent risk factors for residual lesions in multivariate analysis. Conclusions Our study revealed that positive incisal margins and ECC (≥ CIN2) were risk factors for residual lesions, while glandular involvement and VaIN were protective factors. In later clinical work, colposcopic pathology revealed that glandular involvement was associated with a reduced risk of residual uterine lesions. 60% of the patients with residual uterine lesions were menopausal patients, and all patients with carcinoma in situ in this study were menopausal patients. Therefore, total hysterectomy may be a better choice for treating CIN in menopausal patients with positive margins and positive ECC.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

Wang,

2024

BMC Women's Health

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“…HPV infection has been confirmed by multiple studies as an important predictive indicator for residual CIN lesions ( 5 , 22 , 23 ). In this study, the post-LEEP follow-up HPV infection status was closely related to the presence of residual CIN3 lesions after LEEP, and it can serve as an independent predictive indicator for residual lesions in CIN3 patients undergoing LEEP.…”

Section: Discussionmentioning

confidence: 84%

“…Other way, we do not rule out the possibility that this could be caused by collinearity between the variables, as well as potential selection bias and a relatively short follow-up period (18). HPV infection has been confirmed by multiple studies as an important predictive indicator for residual CIN lesions (5,22,23). In this study, the post-LEEP follow-up HPV infection status was closely related to the presence of residual CIN3 lesions after LEEP, and it can serve as an independent predictive indicator for residual lesions in CIN3 patients undergoing LEEP.…”

Section: Discussionmentioning

confidence: 99%

A predictive model for residual lesions after LEEP surgery in CIN III patients

Deng,

Wang,

Chen

et al. 2023

Front. Med.

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Background and aimsThe 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.MethodsA 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.ResultsThere 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).ConclusionThe 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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Value of intraoperative post-conisation human papillomavirus testing in predicting residual or recurrence after treatment with a loop electrosurgical excision procedure in women with HR-HPV positive and cervical high-grade squamous intraepithelial lesion

Xia,

Dai,

et al. 2024

BMC Cancer

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Objective To evaluate the feasibility of intraoperative human papillomavirus (IOP-HPV) testing for the prediction of postoperative treatment failure in patients with high-grade squamous intraepithelial lesion (HSIL) undergoing loop electrosurgical excisional procedure (LEEP). Methods A total of 114 women diagnosed with HSIL by biopsy and/or endocervical curettage who underwent LEEP were included in a prospective cohort study. IOP-HPV testing was performed immediately after the procedure. Patients were followed up for 24 months. Logistic regression was used to analyse the factors influencing the residual or recurrent lesions. Further stratified analyses were performed to investigate the differences in prognosis of IOP-HPV positivity in patients of different age and menopausal status. Results 1. Of the 114 patients, 6 (5.26%) were pathologically upgraded to cervical cancer, and 21 (18.42%) were lost to follow-up. Recurrence or residual HSIL lesions occurred in 9.20% (8/87) of cases. Of the 8 women who developed post-treatment HSIL, 7 (26.92%) were positive for IOP-HPV, and only 1 (1.64%) was negative for IOP-HPV (< 0.01). 2. Transformation zones of type 2 ( P = 0.0306) or type 3 ( P = 0.0446), diagnosed as LSIL/negative by cervical biopsy ( P = 0.0396), margin involvement ( P = 0.0233), positive endocervical curettage after conisation ( P = 0.0028), intraoperative HPV-positive ( P < 0.01), cytological abnormalities ( P = 0.0038), DNA ploidy positivity ( P = 0.0172), postoperative HPV ( P < 0.01) and DNA ploidy ( P = 0.0078) positivity at 6 months were associated with higher risk of residual or recurrent lesions. 3. The results of the multivariate regression analysis showed that IOP-HPV positivity was the independent risk factor for residual or recurrent lesions (OR=10.69 , 95% CI:3.41, 33.51, P<0.01). IOP-HPV positivity was strongly associated with the occurrence of residual/recurrent LSIL (OR=6.42 , 95% CI:1.74, 23.70, P =0.0053) and HSIL (OR=32.08 , 95% CI:3.60, 285.64, P =0.0019). 4. Stratified analyses showed that IOP-HPV positive in patients younger than 50 years or premenopausal patients was associated with a significantly higher risk of recurrence or residual lesions ( p <0.05). Conclusions IOP-HPV positivity is an independent risk factor for residual or recurrent HSIL lesions. In addition, IOP-HPV positivity was more associated with residual or recurrent lesions in those younger than 50 years or premenopausal. IOP-HPV testing may be of critical clinical value in providing the early and accurate prediction of residual or r...

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Analysis of outcomes following loop electrosurgical excision and clinical features of patients with cervical high-grade squamous intraepithelial lesions with abnormal preoperative endocervical curettage

Cited by 5 publications

References 28 publications

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

A predictive model for residual lesions after LEEP surgery in CIN III patients

Value of intraoperative post-conisation human papillomavirus testing in predicting residual or recurrence after treatment with a loop electrosurgical excision procedure in women with HR-HPV positive and cervical high-grade squamous intraepithelial lesion

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