Determination of Recurrent/Residual CIN-II and CIN-III After Leep, Cytology or HPV-DNA?

Öz

Objective: Having some advantages, LEEP becomes the standard treatment of CIN-II and III lesions. However, failure to treatment after LEEP is also seen as in other treatment methods. This study aims to determine the value of cervical cytology, surgical margin positivity and HPV-DNA testing for determination of residual or recurrent disease in patients undergone LEEP with the diagnosis of CIN II or III. 

Material and Method: Colposcopy directed biopsy and endocervical curettage applied 77 cases six months after initial LEEP treatments were retrospectively analyzed. Histological examination is used in order to determine residual/recurrent disease. Cytology and HPV-DNA PCR tests after six months and initial surgical margin positivity at the time of LEEP were all compared.

Results: In 14 (18.1%) of the 77 cases, residual/recurrent disease was determined. HR-HPV was positive in 13 (17%) and negative in 64 (83%). Recurrent/residual disease rate was found to be 12/13 (92%) in HR-HPV positive cases and 2/64 (3%) in HR-HPV negative cases. Out of 25 patients who were surgical margin positive, recurrent/residual disease was determined in 7 (28%). Cytology was positive in 26 (33.8%) cases. Recurrent/residual disease was determined in 2 of the cytology negative and in 12 of the cytology positive cases.

In prediction of residual/recurrent disease, HPV testing was found to be superior to surgical margin positivity or conventional cytology. 

Conclusion: HPV test may be considered primarily for determination of treatment failures after LEEP.

Anahtar Kelimeler

• HPV
• Recurrent residuel disease
• CIN2
• CIN3
• LEEP

LEEP sonrası rekürren/rezidüel CIN 2-3 belirlenmesi, sitoloji mi, HPV DNA mı?

Öz

Amaç: Bazı avantajlara sahip olan LEEP uygulaması CIN-II ve III lezyonlarının standart tedavisi haline gelmiştir. Ne yazık ki,diğer tedavi yöntemlerinde olduğu gibi tedavi başarısızlıkları LEEP uygulaması sonrasında da görülebilmektedir. Bu çalışma CIN II veya III nedeniyle LEEP yapılan olgularda rekürren/ rezidüel hastalık belirlenmesinde servikal sitoloji, cerrahi sınır pozitifliği ve HPV DNA testinin değerini ortaya koymayı amaçlamaktadır.

Gereç ve Yöntem: LEEP tedavisi uygulanmış ve altı ay sonrasında kolposkopi yönlendirilmiş biyopsi ve endoservikal küretaj yapılmış 77 olgu retrospektif olarak incelendi. Rekürren / rezidüel hastalık tespiti için histolojik inceleme uygulanmıştı. LEEP esnasındaki cerrahi sınır pozitifliği, altı ay sonrasında alınan sitoloji ve HPV DNA PCR test sonuçları karşılaştırmaya dahil edildi.

Bulgular: Rekürren / rezidüel hastalık 77 olgunun 14’ünde (%18,1) belirlenmiştir. HR-HPV 13 (%17) olguda pozitif ve 64 (%83) olguda negatifti. Rekürren / rezidüel hastalık oranı HR-HPV pozitif olgularda 12/13 (%92), ve HR-HPV negatif olgularda 2/64 (%3) olarak saptandı. Cerrahi sınır pozitifliği olan 25 olgunun ise 7’sinde (%28)   rekürren / rezidüel hastalık saptandı. Sitoloji 26 (%33,8) olguda pozitifti. . Rekürren / rezidüel hastalık sitolojis negatif olan 2 olguda ve sitolojisi pozitif olan 12 olguda saptandı.

Rekürren / rezidüel hastalık öngörmede HPV testinin cerrahi marjin pozitifliğinden veya konvansiyonel sitolojiden daha üstün olduğu görüldü.

Sonuç: HPV testi LEEP sonrası tedavi başarısızlığını belirlemede ilk planda kullanılabilir.

Anahtar Kelimeler

• HPV
• Rekürren rezidüel hastalık
• CIN 2
• CIN 3
• LEEP

Kaynakça

1. Garcia-Hernandez E, Gonzalez-Sanchez JL, Andrade-Manzano A et al. Regression of papilloma high-grade lesions (CIN 2 and CIN 3) is stimulated by therapeutic vaccination with MVL E2 recombinant vaccine. Cancer Gene Ther. 2006 June;13(6):592–7.
2. Pinda AV, Crum CP, Natural history of cervical neoplasia :defining progression and its consequences. Clin Obstet Gynecol. 2000 Jun;43(2):352-62
3. Nuovo J, Melnikow J, Willan AR, Chan BK Treatment Outcomes for squamous intraepithelial lesion. Int J Gynaecol Obstet. 2000 Jan;68(1):2553-68
4. Wright TC Jr, Massad LS, Dunton CS, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus guidelines for the management of woman with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis 2007 Oct;11(4):223-239
5. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer world wide J Pathol. 1999 Sep;189(1);12-19
6. Costa S, De Simone P, Venturoli S et al. Factors predicting human papillomavirus, clearance in cervical intraepithelial neoplasia lesion treated by conization Gynecol Oncol. 2003 Aug;90(2):358-365.
7. Strander B, Ryd W, Wallin KL, Varelby B, Zheng B et al. Does HPV status 6-12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence Eur J Cancer 2007 Aug;43(12):1849-1855.
8. Sarian LO, Derchain SF, Andrade LA,Tambascia J, Morris SS et al. HPV DNA test and PAP smear in detection of residual/recurrent disease following loop electrosurgical excision procedure of high-grade cervical intraepithelial neoplasia. Gynecol Oncol. 2004 Jul;94(1):181-186

9. Aschkenazi-Steinberg SO, Spitzer BJ, Spitzer M, Lesser M, The clinical usefulness of human papillomavirus testing in the follow-up of women after treatment for cervical intraepithelial neoplasia. J Low Genit Tract Dis. 2004 Oct;8(4):304-307.
10. Zielinski GD, Bais AG, Helmerhorst TJ, Verheijen RH et al. HPV testing and monitoring of women after treatment of CIN-3 A review of the literature and meta-analysis. Obstet Gynecol Surv. 2004 Jul;59(7):543-553.