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

Öz

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.

Anahtar Kelimeler

• HSIL
• LEEP
• Konizasyon
• HPV

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

Öz

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.

Anahtar Kelimeler

• HSIL
• LEEP
• conization
• HPV

Kaynakça

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