Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Li, Yanyun; Gong, Yao; Wang, Qing; Gao, Shujun; Zhang, Hongwei; Xie, Feng; Cong, Qing; Chen, Limei; Zhou, Qi; Hong, Zubei; Qiu, Lihua; Li, Fang; Xie, Yu; Sui, Long

doi:10.2147/ijwh.s329129

Cited by 4 publications

(4 citation statements)

References 37 publications

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“…Occult cervical cancer, i.e., unsuspected invasive cancer diagnosed by conization or hysterectomy, is reported in recent large studies to have an incidence of 0.31–1.6%. 26 , 27 Preoperative diagnosis may not be possible even with common cervical cancer, making it even more challenging with cervical cancer exhibiting multicystic lesions.…”

Section: Discussionmentioning

confidence: 99%

Novel Strategy for the Management of Cervical Multicystic Diseases

et al. 2023

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Purpose To investigate the clinical practices of diagnosing multicystic cervical lesions as a means to develop a more appropriate diagnostic algorithm for gastric-type adenocarcinoma (GAS) and its precursors. Methods Clinical information for 159 surgically treated patients for multicystic disease of the uterine cervix was collected from 15 hospitals. We performed a central review of the MRI and pathological findings. The MRI findings were categorized into four types including two newly proposed imaging features based on the morphology and distribution of cysts, and the diagnosis accuracy was assessed. Among the four MRI types, types 1 and 2 were categorized as benign lesions that included LEGH; type 3 were precancerous lesions (with an assumption of atypical LEGH); and type 4 were malignant lesions. Results The central pathological review identified 56 cases of LEGH, seven with GAS, four with another form of carcinoma, and 92 with benign disease. In clinical practice, over-diagnosis of malignancy (suspicion of MDA) occurred for 12/19 cases (63.2%) and under-diagnosis of malignancy occurred for 4/11 (36%). Among the 118 patients who had a preoperative MRI and underwent a hysterectomy, type 3 or 4 MRI findings in conjunction with abnormal cytology were positively indicative of premalignancy or malignancy, with a sensitivity and specificity of 61.1% and 96.7%, respectively. Conclusions Although the correct preoperative diagnosis of cervical cancer with a multicystic lesion is challenging, the combination of cytology and MRI findings creates a more appropriate diagnostic algorithm that significantly improves the diagnostic accuracy for differentiating benign disease from premalignancy and malignancy.

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Section: Discussionmentioning

confidence: 99%

Novel Strategy for the Management of Cervical Multicystic Diseases

et al. 2023

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“…The positive rate of cervical lesions detected by ECC is inconsistent across the multiple studies undertaken. In one prospective study of 1,299 patients, there was a 72.4% diagnostic agreement between colposcopic targeted biopsy combined with ECC and specimens after cervical coning ( 10 ). In another study evaluating 150 patients with HSIL+ using the pathological results of postoperative conical specimens as the final criterion, colposcopic targeted biopsy combined with ECC had a 79% coincidence rate for a cervical HSIL+ diagnosis ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Additional role of ECC in the detection and treatment of cervical HSIL

Sijing,

Ying,

Jing

et al. 2023

Front. Med.

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ObjectiveTo probe into the additional role of ECC in the detection of cervical HSIL. The primary objective was to risk-stratify HSIL patients according to ECC so as to provide clinical suggestions for subsequent treatment.MethodsRetrospective analysis of medical records for patients with HSIL. All patients underwent both ECC and cervical biopsy. According to the results of colposcopic targeted biopsy and ECC, the patients were divided into three groups: (1) ECC negative group (those whose colposcopic targeted biopsy indicated HSIL, but ECC indicated LSIL or chronic inflammation); (2) Only the ECC positive group (those whose ECC suggested HSIL, but colposcopic targeted biopsy showed LSIL or chronic inflammation); (3) ECC and biopsy positive group (those whose ECC and targeted biopsy were both HSIL). Chi-square test was used to analyze the differences of lesion residue and biopsy results after LEEP amongst the three groups.ResultsA total of 1,146 medical records were analyzed. The diagnostic accuracy of ECC combined with colposcopic targeted biopsy for HSIL was higher than that of colposcopic biopsy alone (72.43% vs. 67.54%). When ECC indicated HSIL, the coincidence rate of ECC combined with colposcopic targeted biopsy and the histological pathology of LEEP was 86.25%, and the proportion of residual lesions after LEEP was 41.43%. When ECC and targeted biopsy both indicated HSIL, HSIL or worse lesions were confirmed in 90.68% of patients after surgery. Of these, 10.77% were confirmed as cervical invasive carcinoma. Moreover, the positive rate of LEEP resection margin and postoperative ECC in these patients was 43.48%.ConclusionECC can improve the detection rate of cervical HSIL and reduce missed diagnosis. Also ECC can help clinicians predict the proportion of residual lesions after LEEP. This provides the gynecologists with a reference for the need to increase the depth of the procedure and the need to perform ECC for the residual cervical canal.

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“…Las últimas guías destacan la necesidad de nuevos biomarcadores y de no utilizar únicamente los hallazgos citohistológicos para el manejo y la prevención de estas lesiones 2,14 . Los estudios anteriores han mostrado tasas de concordancia muy diferentes entre los resultados histológicos de BGC y de la conización, que van del 42% al 85,5% [3][4][5][6][7][8][9][10][11][12][13] . Posibles explicaciones de estas discrepancias podrían ser las diferencias en el diseño del estudio, la población incluida o la clasificación de las lesiones precursoras utilizada.…”

Section: Discussionunclassified

“…La indicación de tratamiento de las lesiones precursoras se basa en el diagnóstico histológico de lesiones intraepiteliales escamosas de alto grado (HSIL) o de neoplasia intraepitelial cervical de grado 2 o superior (HSIL/CIN2+) en la biopsia guiada por colposcopia (BGC) 2 . Sin embargo, se ha informado de que las tasas de concordancia entre la BGC y la conización oscilan entre el 42% y el 85,5% [3][4][5][6][7][8][9][10][11][12][13] . Esto podría implicar la no detección de lesiones de alto grado con posible progresión a cáncer cervical y el sobretratamiento de otras lesiones de bajo riesgo.…”

Section: Introductionunclassified