Konizasyon Sonrası Erken Dönem Takip: Cerrahi Sınır Durumu ve HPV Negatifleşmesi, Rekürrens İlişkisi

Yıl 2025, Cilt: 25 Sayı: 3, 112 - 117, 25.12.2025

Gülsüm Ekin Sari , Görker Sel , Erinç Tekin , Harun Reşit Türkmenoğlu , Yegana Sadıgova , Aysun Alcı , Mete Can Ateş , Mehmet Göksu

Öz

ÖZET

Giriş: Konizasyon, CIN hastalarının tedavisinde yaygın olarak kullanılan bir cerrahi yaklaşımdır. Bu çalışmada konizasyon yapılan hastalarda, cerrahi sınır durumu ile HPV negatifleşmesi ve rekürrens arasındaki ilişki retrospektif olarak değerlendirilmiştir.

Materyal ve Metod: Ocak 2015 ile Mayıs 2016 tarihleri arasında HSIL ön tanısıyla konizasyon yapılan hastaların bir yıl içindeki sonuçları değerlendirilmiştir. Çalışmada, cerrahi sınır durumu, HPV negatifleşmesi ve rekürrens (CIN2/3) gelişimi arasındaki ilişki retrospektif olarak değerlendirilmiştir.

Bulgular: Konizasyon yapılan 72 hastanın 44’ü (%61.1) 1 yıl içinde kontrole geldi. Bu hastaların 14’ünde cerrahi sınır pozitif, 30’unda cerrahi sınır negatif idi. Cerrahi sınır pozitif olan hastaların %36’sında (n=5/14) CIN2/3 bulunurken, cerrahi sınır negatif olan hastaların %3.3’ünde (n=1/30) CIN2/3 bulundu (p=0.036).

Sonuç: Çalışma bulguları, cerrahi sınır pozitifliğinin rekürren hastalık gelişimiyle anlamlı ilişki gösterdiğini ve HPV negatifleşmesinin güven verici bir belirteç olduğunu göstermiştir.

Anahtar Sözcükler: Konizasyon, CIN, HPV, rekürrens, cerrahi sınır

Anahtar Kelimeler

Konizasyon , CIN , HPV , rekürrens , cerrahi sınır

Etik Beyan

Bu çalışma retrospektif olarak planlanmış olup, etik kurul onayı gerektirmemektedir

Destekleyen Kurum

Bu çalışma herhangi bir kurum veya kuruluş tarafından desteklenmemiştir

Early Post-Conization Follow-Up: Association Between Surgical Margin Status, HPV Clearance, and Recurrence

Öz

ABSTRACT

Objective: Conization is a commonly used surgical approach in the treatment of CIN patients. This study retrospectively evaluated the relationship between surgical margin status, HPV negativization, and recurrence in patients who underwent conization.

Materials and Methods: Patients who underwent conization between January 2015 and May 2016 for a preliminary diagnosis of HSIL were evaluated for one-year outcomes. The relationship between surgical margin status, HPV negativization, and recurrence (CIN2/3) was analyzed retrospectively.

Results: Of the 72 patients who underwent conization, 44 (61.1%) attended follow-up within one year. Fourteen had positive and 30 had negative surgical margins. CIN2/3 was found in 36% (n=5/14) of margin-positive patients and in 3.3% (n=1/30) of margin-negative patients (p=0.036).

Conclusion: Surgical margin positivity was significantly associated with recurrent disease, while HPV negativization was found to be a reassuring biomarker.

Keywords: Conization, CIN, HPV, recurrence, surgical margin

Anahtar Kelimeler

Conization , CIN , HPV , recurrence , surgical margin

Etik Beyan

This retrospective study did not require approval from an ethics committee.

Destekleyen Kurum

This research received no external funding.

Kaynakça

• Arbyn M, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–e203.
• Wright TC Jr, 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):102–131.
• Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–249.
• WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: World Health Organization; 2020.
• Martin-Hirsch PP, et al. Surgical treatment of cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2013;(12):CD001318.
• Kyrgiou M, et al. Fertility-sparing management and oncological outcomes after treatment of cervical intraepithelial neoplasia: a review. Lancet Oncol. 2015;16(2):e52–e62.
• Ghaem-Maghami S, et al. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol. 2007;8(11):985–993.
• Liu AH, et al. Positive margins after cervical conization and the risk of residual or recurrent disease: a systematic review and meta-analysis. J Gynecol Oncol. 2020;31(2):e49.
• Cuschieri K, et al. Post-treatment HPV testing for residual or recurrent cervical intraepithelial neoplasia. J Clin Virol. 2016;76(Suppl 1):S40–S46.
• NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer Screening. Version 2.2025.
• ESGO/ESTRO/ESP Guidelines for management of cervical precancer. Int J Gynecol Cancer. 2023;33(3):302–320.
• ESMO Clinical Practice Guidelines for cervical cancer. Ann Oncol. 2023;34(3):191–208.
• Loopik DL, et al. Risk factors for residual disease after cervical conization in CIN3: a systematic review and meta-analysis. Gynecol Oncol. 2021;162(2):577–585.
• Bogani G, et al. Recurrence rate after conization for cervical intraepithelial neoplasia: a 10-year follow-up study. Gynecol Oncol. 2017;144(3):594–598.
• Matsumoto K, et al. Predictors of residual disease and recurrence after conization for CIN3: a retrospective study of 450 cases. Int J Clin Oncol. 2018;23(3):512–518.
• Arbyn M, et al. Detection of residual/recurrent disease after treatment of cervical precancer using HPV testing: a systematic review and meta-analysis. BMJ. 2018;363:k4999.
• Paraskevaidis E, et al. Conservative management of CIN and cancer risk: meta-analysis. Obstet Gynecol. 2004;104(2):377–383.