See and treat strategy by LEEP conization in patients with abnormal cervical cytology

Demirkıran, Fuat; Kahramanoğlu, İlker; Turan, Hasan; Yılmaz, Nevin; Yurtkal, Aslıhan; Meşeci, Elif; Beşe, Tugan; İlvan, Şennur; Arvas, Macit

doi:10.5603/gp.a2017.0066

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Under clinical conditions including: an unsatisfactory colposcopy; atypical squamous cells of undetermined significance (ASCUS) in cytology and positive HPV but without visible lesion under the colposcopy; ≥LSIL in cytology and no lesion under colposcopy; HSIL cytology; atypical glandular cells (AGC); or a suspected invasive disease, ECC was suggested as the prioritizable method ( 30 ). In our study, we also found that the HSIL of ECC was a risk factor for positive margins, which was supported by the previous study that the risk of surgical margins with positive ECC was increased ( 31 ). At present, TCT and ECC are mainly used for cervical cancer screening and diagnosis, but their impact on prognosis is often ignored clinically.…”

Section: Discussionsupporting

confidence: 91%

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Zhu

Chen

et al. 2022

Front. Med.

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IntroductionCurrently, 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 MethodsA 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.ResultsThe 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).ConclusionsThis 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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Section: Discussionsupporting

confidence: 91%

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Zhu

Chen

et al. 2022

Front. Med.

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“…The final outcome, separated into 2 predefined situations A and B, showed the following results: in 7 articles with situation A (negative colposcopy not followed by a biopsy), [11, 14, 15, 21, 23, 24, 34] the mean PPV of HSIL for histological CIN2+ was 66.3%. In situation B (negative colposcopy followed by a four-quadrant punch biopsy or random biopsies), 15 included studies [5, 9, 12, 15, 16, 18, 20, 22, 25, 26, 28-31, 33] showed a mean PPV of 78.6%.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 15 articles did not clearly describe the method of cytology [5, 9-11, 14, 17, 19, 20, 28-34]. Concerning the version of the Bethesda classification, the most frequently reported version was the 2001 classification, with the exception of 3 articles [11, 15, 21] in which the 1991 version was applied.…”

Section: Resultsmentioning

confidence: 99%

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The Positive Predictive Value of High-Grade Squamous Intraepithelial Lesion on Cytology for the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 or Higher: A Systematic Review

et al. 2019

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Cervical cancer is a major worldwide health problem. Therefore, regular cervical screening in order to make an early diagnosis can help to prevent cervical cancer, through identifying and treating preinvasive cervical lesions. The aim of this review is to evaluate the correlation between the cytological screening result and the final gold standard histological outcome in the diagnosis of cervical lesions. More specifically, the correlation between high-grade intraepithelial lesion (HSIL) on cytology and histological cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was intended, by calculating the positive predictive value (PPV). PPV is an important value from a clinical point of view. An electronic search was carried out in the electronic databases MEDLINE (through PubMed) and the Cochrane Library (last searched beginning of December 2017), supplemented with the related article feature in PubMed and snowballing. Article selection (predefined inclusion and exclusion criteria) and data extraction were evaluated by two independent reviewers (N.K. and A.V.L.). After identifying 1,146 articles, 27 articles were finally included in this systematic review, representing 28,783 cytological HSIL diagnoses in total. The PPV of HSIL was 77.5% (range: 45.4–95.2%) for the histological diagnosis of CIN2+ and 55.4% (range: 36.4–67.6%) for the diagnosis of CIN3+. In this systematic review, 77.5% of the HSIL-positive women eventually had a CIN2+ diagnosis. The diagnostic value of a cytological HSIL result (conventional or liquid-based cytology) in the diagnosis of CIN2+ lesions is good, but a combination of tests could raise this value.

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The use of colposcopic punch biopsy in the management of abnormal cervical cytology: a 5–year retrospective audit

Kahramanoğlu

Demirkıran

Turan

et al. 2018

Journal of Obstetrics and Gynaecology

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The aim of this study was to determine the accuracy of colposcopic punch biopsy to detect cervical epithelial neoplasia (CIN) II + in patients with abnormal cervical cytology and the major colposcopic findings in patients who underwent a loop electrosurgical excision procedure (LEEP), subsequently. A total of 231 patients with abnormal cervical cytology who underwent a colposcopy guided cervical biopsy and subsequent LEEP were analysed. The mean age was 33.4 ± 8.7 years. CIN II + rate on LEEP pathology was significantly higher in patients with high-grade cytology, compared to those with a low-grade cytology (92 vs. 55%, p < .0001). CIN II + was found in 80, 98 and 100% of colpocopic biopsies of patients with LSIL, HSIL and AGC, respectively. The overall concordance rate between a colposcopic biopsy and LEEP was 41% with a kappa coefficient. The overall underestimation of CIN II + was 10.5%. On a patient-based analysis, the sensitivity, specificity, PPV and NPV of colposcopic biopsy were 89.4, 47.1, 79.5 and 66%, respectively. More than two cervical biopsies had 100% sensitivity for CIN II + on LEEP pathology. The specificity and PPV decreased with increasing number of cervical biopsies. A see-and-treat strategy may be considered for high-grade cytologies. Patients with a low-grade cytology should be managed with more than two colposcopic biopsies.

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See and treat strategy by LEEP conization in patients with abnormal cervical cytology

Cited by 6 publications

References 21 publications

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

The Positive Predictive Value of High-Grade Squamous Intraepithelial Lesion on Cytology for the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 or Higher: A Systematic Review

The use of colposcopic punch biopsy in the management of abnormal cervical cytology: a 5–year retrospective audit

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