Yüksek dereceli skuamöz intraepitelyal lezyonlarda eksizyonel işlemler sonrası cerrahi sınır pozitifliğini etkileyen faktörler

Abstract

Amaç: Servikal preinvaziv lezyonlarda eksizyonel işlemler sonrası cerrahi sınır pozitifliği için risk faktörlerinin değerlendirilmesi Gereçler ve Yöntem: Şubat 2007 ile Eylül 2018 tarihleri arasında Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesinde yüksek dereceli skuamöz intraepitelyal lezyon (HSIL) / servikal intraepitelyal neoplazi (CIN2-3) nedeniyle konizasyon [soğuk konizasyon veya loop elektrocerrahi eksizyon prosedürü (LEEP)] yapılmış hastaların tıbbi kayıtları retrospektif olarak değerlendirildi. Çalışmada hastaların klinik ve demografik özellikleri (yaş, sigara kullanımı, parite, konizasyon öncesi servikal sitoloji, human papilloma virüs (HPV) varlığı, eksizyonel işlemin tipi), konizasyon materyalinin boyutları (horizantal ve vertikal çap) ve cerrahi sınır durumu (pozitif veya negatif) analiz edildi. Bulgular: Konizasyon (LEEP veya soğuk konizasyon) sonrası çalışma kriterlerine uyan toplam 1341 hasta analize dahil edildi. Hastaların %55,1’ine (739/1341) soğuk konizasyon ve %44,9’una (602/1341) LEEP yapılmıştı. Tüm grup incelendiğinde cerrahi sınır pozitiflik oranını toplamda %36,2 olarak bulduk. Soğuk konizasyon yapılan hastalarda cerrahi sınır pozitifliği oranı %30,3 (224/739), LEEP yapılan hastalarda ise bu oran %43,3 (261/602) olarak saptadık (p<0,001). Cerrahi sınır pozitiflik riskini, cerrahi öncesi servikal sitolojinin HSIL, atipik skuamöz hücreler- HSIL ekarte edilemediği (ASC-H) veya atipik glandüler hücreler (AGC) olmasının 1,43 kat [%95 güven aralığı (CI), 1,12-1,84; p=0,004] ve soğuk konizasyon yerine LEEP yapılmasının 1,69 kat [%95 CI, 1,30-2,19; p<0,001] arttırdığı gösterildi. Sonuç: Konizasyon öncesi yüksek dereceli servikal sitoloji varlığı ve hastalara soğuk konizasyon yerine LEEP yapılmasının pozitif cerrahi sınırı predikte eden risk faktörleri olduğunu bulduk.

Keywords

• HSIL
• LEEP
• Konizasyon
• HPV

Factors effecting the surgical margin positivity in high grade squamous intraepithelial lesions after excisional procedures

Abstract

Aim: Evaluation of risk factors for positive surgical margins after excisional procedures in cervical preinvasive lesions Materials and Method: The records of the patients who underwent cervical conization [cold conization or loop electrosurgical excision procedure (LEEP)] for high-grade squamous intraepithelial lesion (HSIL) / cervical intraepithelial neoplasia (CIN2-3) at Zekai Tahir Burak Women's Health Training and Research Hospital between February 2007 and September 2018, were evaluated retrospectively. Clinical and demographic characteristics of the patients (age, smoking, parity, cervical cytology before conization, presence of human papilloma virus (HPV), type of excisional procedure), dimensions of the conization material (horizontal and vertical diameter), and surgical margin status (positive or negative) were analyzed. Results: A total of 1341 patients who met the study criteria after conization [LEEP or cold knife conization (CKC)] were included in the analysis. CKC was performed in 55.1% (739/1341) and LEEP was performed in 44.9% (602/1341) of the patients. Positive surgical margin rate was 36.2% for the entire cohort. We found the positive surgical margin rate 30.3% (224/739) in patients who underwent CKC, and 43.3% (261/602) in patients who underwent LEEP (p<0.001). It was shown that the risk of surgical margin positivity increased 1.43-folds [95% confidence interval (CI), 1.12-1.84] in the presence of for HSIL, atypical squamous cells-cannot be excluded HSIL (ASC-H) or atypical glandular cells (AGC) before the conization, and 1,69 -folds [95% confidence interval (CI), 1,30-2,19; p<0,001] in the patients underwent LEEP instead of CKC. Conclusion: We found that the presence of high-grade cervical cytology before conization and performing LEEP instead of CKC as the risk factors predicting a positive surgical margin.

Keywords

• HSIL
• LEEP
• conization
• HPV

References

1. 1. Arbyn M, Redman CWE, Verdoodt F, Kyrgiou M, Tzafetas M, Ghaem-Maghami S, et al. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol. 2017;18(12):1665-79.
2. 2. Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch Pathol Lab Med. 2012;136(10):1266-97.
3. 3. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020;24(2):102-31.
4. 4. Sopracordevole F, J DIG, Mancioli F, G DEP, Buttignol M, Ciavattini A. Procedures of cervical conization: a national survey among Italian colposcopy units. Minerva Ginecol. 2016;68(2):219-23.
5. 5. Shaco-Levy R, Eger G, Dreiher J, Benharroch D, Meirovitz M. Positive margin status in uterine cervix cone specimens is associated with persistent/recurrent high-grade dysplasia. Int J Gynecol Pathol. 2014;33(1):83-8.
6. 6. Kong TW, Son JH, Chang SJ, Paek J, Lee Y, Ryu HS. Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, and microinvasive carcinoma of the uterine cervix. Gynecol Oncol. 2014;135(3):468-73.
7. 7. Chikazawa K, Netsu S, Motomatsu S, Konno R. Predictors of recurrent/residual disease after loop electrosurgical excisional procedure. J Obstet Gynaecol Res. 2016;42(4):457-63.
8. 8. Orbo A, Arnesen T, Arnes M, Straume B. Resection margins in conization as prognostic marker for relapse in high-grade dysplasia of the uterine cervix in northern Norway: a retrospective long-term follow-up material. Gynecol Oncol. 2004;93(2):479-83.

9. 9. Kalogirou D, Antoniou G, Karakitsos P, Botsis D, Kalogirou O, Giannikos L. Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease. Eur J Gynaecol Oncol. 1997;18(2):113-6.
10. 10. Chen L, Liu L, Tao X, Guo L, Zhang H, Sui L. Risk Factor Analysis of Persistent High-Grade Squamous Intraepithelial Lesion After Loop Electrosurgical Excision Procedure Conization. J Low Genit Tract Dis. 2019;23(1):24-7.
11. 11. Sun XG, Ma SQ, Zhang JX, Wu M. Predictors and clinical significance of the positive cone margin in cervical intraepithelial neoplasia III patients. Chin Med J (Engl). 2009;122(4):367-72.
12. 12. Giannella L, Di Giuseppe J, Prandi S, Delli Carpini G, Tsiroglou D, Ciavattini A. What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status? Eur J Obstet Gynecol Reprod Biol. 2020;244:180-4.
13. 13. 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(9):2569-72.
14. 14. Liss J, Alston M, Krull MB, Mazzoni SE. Predictors of Positive Margins at Time of Loop Electrosurgical Excision Procedure. J Low Genit Tract Dis. 2017;21(1):64-6.
15. 15. Aerssens A, Claeys P, Beerens E, Garcia A, Weyers S, Van Renterghem L, et al. Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia. Cytopathology. 2009;20(1):27-35.
16. 16. Panna S, Luanratanakorn S. Positive margin prevalence and risk factors with cervical specimens obtained from loop electrosurgical excision procedures and cold knife conization. Asian Pac J Cancer Prev. 2009;10(4):637-40.
17. 17. Jiang YM, Chen CX, Li L. Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia. Onco Targets Ther. 2016;9:3907-15.