Role of Close Endocervical Margin in Treatment Failure After Cervical Excision for Cervical Intraepithelial Neoplasia: A Retrospective Study

Sopracordevole, Francesco; Carpini, Giovanni Delli; Fabro, Anna Del; Serri, Matteo; Alessandrini, Lara; Buttignol, Monica; Canzonieri, Vincenzo; Cagnacci, Angelo; Ciavattini, Andrea

doi:10.5858/arpa.2018-0363-oa

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…These results are consistent with findings by other authors and reinforces current recommendations for strict surveillance in these cases associated with hrHPV testing. 9,29,30 To our knowledge, this is the first 2-center study and the largest study published to date evaluating the clinicopathological factors associated with the absence of HSIL/CIN 2-3 lesion after LEEP treatment. However, it is also limited by the inherent retrospective nature of the study design.…”

Section: Discussionmentioning

confidence: 93%

Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?

Bradbury

Rabasa

Murcia

et al. 2022

J Low Genit Tract Dis

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The aim was to evaluate the cytology, colposcopic, and pathological factors associated with the absence of high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN) 2-3 lesion on loop electrosurgical excision procedure (LEEP) specimens in women with high-grade cytology and/or HSIL/CIN 2-3 biopsy and the risk of disease persistence/recurrence.Materials and Methods: Two-center retrospective study of women undergoing LEEP for high-grade cervical disease between January 2014 and December 2019. Clinical, cytology, colposcopy, and pathology results were evaluated to identify independent predictive factors associated with CIN 1/ negative LEEP results. Univariate and multivariate logistic regression models were performed. Follow-up data was evaluated to assess the risk of HSIL/ CIN 2-3 persistence/recurrence.Results: Six hundred thirty-nine of 801 women (79.8%) had high-grade cytology and 631 (78.8%) HSIL/CIN 2-3 biopsy. High-risk human papillomavirus test was positive in 98% of women. Loop electrosurgical excision procedure specimen showing CIN 1 or less was found in 27%-31%. Normal/low-grade colposcopy (odds ratio [OR] = 2.17, CI = 1.39-3.39, p = .001) and CIN 1/negative biopsy (OR = 3.25, CI = 2.12-4.99, p < .001) were predictors of negative/CIN 1 LEEP result in women with highgrade cytology. Normal/low-grade cytology (OR = 1.77, CI = 1.19-2.64, p = .005), normal/low-grade colposcopy (OR = 1.66, CI = 1.11-2.49, p = .013), and CIN 2 biopsy (OR = 2.75, CI = 1.73-4.39, p < .001) were predictors in women with HSIL/CIN 2-3 biopsy. Women with a negative/ CIN 1 LEEP had lower recurrence/persistence than those with confirmed HSIL/CIN 2-3(1 vs 31, p = .002). Positive endocervical margin (OR = 2.85, CI = 1.10-7.36, p = .03) and high-risk human papillomavirus persistence (OR = 41.3, CI = 16-106.7, p < .01) were predictors of HSIL/CIN 2-3 persistence/recurrence. Conclusions:A CIN 1/negative LEEP specimen in women with highgrade cytology and/or HSIL/CIN 2-3 biopsy is associated with negative/ low-grade cytology, normal/low-grade colposcopic findings and CIN 2 biopsy result before treatment. The HSIL/CIN 2-3 disease persistence/ recurrence is low when LEEP specimen does not confirm HSIL/CIN 2-3.

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Section: Discussionmentioning

confidence: 93%

Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?

Bradbury

Rabasa

Murcia

et al. 2022

J Low Genit Tract Dis

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“…The study which reported the lesser cone depth for adequate treatment of high grade precancerous lesion as similar to our study had many studies in recently. Sopracordevole et al, (2019) reported in his study that from 1996 to 2015 showed a significant decrease in the length of cone excision over the whole study period, with a 30% reduction in the length of cone specimens. Pina et al, (2013) suggested that the shallowest LEEP that will enable complete removal of the lesion should be performed.…”

Section: Discussionmentioning

confidence: 90%

“…High grade precancerous lesion of cervix was currently considered the precursor of invasive cervical cancer (Sopracordevole et al, 2019). The incidence was mostly in late reproductive to premenopausal period, the disease progressed in a gradual period and easier to screening than other organs (Šarenac and Mikov, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we add 8% of depth which reported on the gross examinations after formalin fixation to reflect the true depth of fresh cone specimen. Surgical margins were considered positive when the high grade dysplasia was closer than 1 millimeter to the endocervical or deep margin, however for >1 millimeter distance to the lesion was considered negative (Beyer et al, 2017;Sopracordevole et al, 2019).…”

Section: Methodsmentioning

confidence: 99%

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The Appropriate of Cone Depth in Loop Electrical Excision Procedure (LEEP) for Negative Pathological Margin from High Grade Precancerous Lesion of Cervix, Retrospective Study

Srijarusith

Rodpenpear

2022

Asian Pac J Cancer Prev

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Objective: To determine the appropriate cone depth for treating high grade precancerous lesions to achieve negative pathological margins of cones from LEEPs. Other factors associated with positive pathological margin were also investigated. Methods: A Retrospective study recruited 170 patients who received indications for LEEP during January 2015 to July 2020 were enrolled. The participants were operated by a single cut of LEEP and not had previously conization before. All patient data were collected into two groups, including negative and positive cone margin groups. Then, we used the cone depth by calculating from cone tissue after formalin fixation to eliminate shrinkage effect. The appropriate cut-off points for cone depth were calculated by ROC and analyzed factors that influence positive cone margin. Results: The depth of cone (mm ±SD) of negative margin group was 8.70 (±3.36) and 6.13 (±2.28) mm in positive margin group. The appropriate cut-off points for cone depth were calculated by ROC presented at resection depth of 7.21 mm, which displayed proper cone depth with a sensitivity of 63.53% and specificity of 71.76%. Elderly age (adjusted OR 1.061, 95%CI 1.008-1.117, p=0.002), number of quadrants of lesion involvement (adjusted OR 1.182, 95%CI 1.312-2.513, p=<0.001) and glandular involvement (adjusted OR 3.648, p=0.002) were the significant risk factors for positive margin. Conclusion: The appropriate cone depth for treating high grade precancerous lesions was at least 7.21 mm to achieve a negative cone margin from LEEP. The significant factors associated with positive cone margin include elderly age, more quadrants of lesion involvement and glandular involvement.

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“…16 There are several articles examining failures such as recurrent/residual disease and surgical margin positivity. 17–19 It is a constituted fact that the presence of glandular involvement is associated with increased treatment failure rates and permanent or recurrent lesions. 3,20 Patients with negative surgical margins and the presence of endocervical glandular involvement showed recurrence rates approximately twice as high as those with negative surgical margins and negative glandular involvement.…”

Section: Discussionmentioning

confidence: 99%

Is Endocervical Glandular Involvement Related to The Depth of Cone Biopsy?

et al. 2022

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Introduction. This study aimed to determine whether endocervical glandular involvement by squamous intraepithelial lesion would differ with respect to the depth of the excised specimen and analyze the related factors that may define endocervical glandular involvement among cases treated with cone biopsy. Methods. Between April 2016 and December 2018, women who underwent colposcopy and excisional procedures in the department of gynecologic oncology were retrospectively investigated. Patients with multiple specimens, or whose specimen depths were not measured, and a negative/unknown HPV status were excluded from the study. Also, patients with no dysplasia or microinvasive/invasive cancer in the final pathology report and those who had not undergone endocervical curettage during colposcopy were excluded. HPV genotypes, degree of dysplasia, surgical margin status, and specimen depth were documented from medical records. Further, the association of these factors with endocervical glandular involvement was evaluated. Results: A total of 321 patients who fulfilled the criteria were included in the study, with a mean age of 41.9 years. In total, 101 patients (31.5%) had endocervical glandular involvement. The mean excised specimen depth was 17.04 mm; 17.9 and 16.7 mm for the positive and negative glandular involvement groups, respectively ( p = .13). The mean ages were 42.7 and 41.6 years for these groups, respectively ( p = .32). There was no association between the HPV genotypes and glandular involvement. Conclusions: Endocervical glandular involvement is not associated with the depth of the excised specimen. A deeper cone biopsy may not necessarily enable a more effective treatment of the disease.

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Role of Close Endocervical Margin in Treatment Failure After Cervical Excision for Cervical Intraepithelial Neoplasia: A Retrospective Study

Cited by 5 publications

References 25 publications

Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?

Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?

The Appropriate of Cone Depth in Loop Electrical Excision Procedure (LEEP) for Negative Pathological Margin from High Grade Precancerous Lesion of Cervix, Retrospective Study

Is Endocervical Glandular Involvement Related to The Depth of Cone Biopsy?

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