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首页> 外文期刊>Journal of Clinical Medicine Research >Positive Endocervical Margins at Conization: Repeat Conization or Colposcopic Follow-Up? A Retrospective Study
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Positive Endocervical Margins at Conization: Repeat Conization or Colposcopic Follow-Up? A Retrospective Study

机译：宫颈锥切术阳性宫颈边缘：重复锥切术还是阴道镜随访？回顾性研究

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Background: The presence of residual cervical lesions was evaluated in patients submitted to repeat conization due to a finding of positive endocervical margins in a previous loop electrosurgical excision procedure (LEEP) specimen. In addition, the correlation between the presence of a residual lesion and risk factors for cervical cancer, and the use of repeat conization as first-choice treatment were analyzed.Methods: This retrospective study included 44 patients submitted to repeat cervical conization or total hysterectomy following a finding of affected endocervical margins in LEEP specimens. The risk factors analyzed in relation to the presence of residual lesions were age, smoking, cone depth, glandular involvement and the histopathology findings of cervical intraepithelial neoplasia (CIN) 1, CIN 2 or CIN 3/carcinoma in situ. The Chi-square test and the Mann-Whitney t-test were used, with significance defined at P < 0.05.Results: Residual lesions were found in 23/44 patients (52.3%), with 3/23 cases (13.0%) being compatible with invasive squamous cell carcinoma. Of the 23 patients, six (26.1%) were submitted to total hysterectomy, with one case being compatible with a moderately differentiated invasive squamous cell carcinoma. Two patients with a histopathology finding of CIN 3/carcinoma in situ in the previous LEEP specimen were diagnosed with invasive squamous cell carcinoma in the repeat conization specimen. Residual lesions were not significantly associated with the risk factors evaluated.Conclusions: In view of the high frequency of residual disease found when positive endocervical margins were found in LEEP specimens, the indication for repeat cervical conization rather than colposcopic follow-up is viable and justified. Indeed, since the presence of a residual lesion and its progression in the cervical canal are more difficult to screen and control, patients unable to comply with regular colposcopic follow-up could benefit from repeat conization when trying to avoid a potentially negative outcome.J Clin Med Res. 2015;7(7):540-544doi: http://dx.doi.org/10.14740/jocmr2171w
机译：背景：由于在先前的循环电外科切除程序（LEEP）标本中发现宫颈内切缘阳性，因此对接受重复锥切术的患者进行了残留宫颈病变的评估。此外，还分析了残余病变的存在与宫颈癌危险因素之间的相关性，以及采用重复锥切术作为首选治疗方法。方法：这项回顾性研究纳入了44例在术后再次进行宫颈锥切术或全子宫切除术的患者在LEEP标本中发现受影响的宫颈管缘。与残留病变的存在相关的危险因素为年龄，吸烟，视锥深度，腺体受累以及宫颈上皮内瘤变（CIN）1，CIN 2或CIN 3 /原位癌的组织病理学发现。采用卡方检验和曼恩·惠特尼t检验，其显着性定义为P <0.05。结果：23/44例患者（52.3％）发现残余病变，其中3/23例（13.0％）被发现与浸润性鳞状细胞癌相容。在这23例患者中，有6例（占26.1％）接受了全子宫切除术，其中1例与中度分化浸润性鳞状细胞癌兼容。在先前的LEEP样本中，两名在组织病理学上原位发现CIN 3 /癌的患者在重复锥切样本中被诊断为浸润性鳞状细胞癌。结论：鉴于在LEEP标本中发现宫颈内切缘阳性时发现残留疾病的频率很高，因此提示重复宫颈锥切术而不是阴道镜随访是可行和合理的。 。确实，由于残留病变的存在及其在子宫颈管中的进展更难以筛查和控制，因此在不进行常规阴道镜随访的患者中，尝试避免可能的阴性结果时，可以通过重复锥切术受益。 Med Res。 2015; 7（7）：540-544doi：http://dx.doi.org/10.14740/jocmr2171w

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