阴道镜测量的小病灶大小可能预测转化区大环形切除术标本中不存在宫颈上皮内瘤变。

Small lesion size measured by colposcopy may predict absence of cervical intraepithelial neoplasia in a large loop excision of the transformation zone specimen.

机构信息

Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.

Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona) - Hospital Clínic, University of Barcelona, Barcelona, Spain.

出版信息

BJOG. 2017 Feb;124(3):495-502. doi: 10.1111/1471-0528.14247. Epub 2016 Aug 9.

DOI:10.1111/1471-0528.14247

PMID:27506510

Abstract

OBJECTIVE

To evaluate whether colposcopic measurement of the lesion size at diagnosis and/or human papillomavirus (HPV) genotyping can predict the absence of dysplasia in a large loop excision of the transformation zone (LLETZ) specimen in women treated for squamous intraepithelial lesions/cervical intraepithelial neoplasia (SIL/CIN).

DESIGN

Prospective observational study.

SETTING

Tertiary university hospital.

POPULATION

A cohort of 116 women who underwent LLETZ because of biopsy-proven low-grade SIL/CIN that had persisted for 2 years, or because of a high-grade SIL/CIN diagnosed in the referral visit and squamocolumnar junction completely visible (types 1 or 2, according to the International Federation of Cervical Pathology and Colposcopy, IFCPC).

METHODS

After LLETZ the women were classified by histology into the study group (absence of SIL/CIN in the surgical specimen, 28/116, 24.1%) and the control group (SIL/CIN in the LLETZ specimen, 88/116, 75.9%).

MAIN OUTCOME MEASURES

The size of the lesion determined in the diagnostic colposcopy and the HPV genotype were evaluated in all women.

RESULTS

The lesion size was significantly smaller in the study group (25.7 ± 37.8 versus 84.5 ± 81.7 mm ; P < 0.001). A lesion size of ≤12 mm and HPV types other than 16 or 18 were associated with an absence of SIL/CIN in the LLETZ specimen (P < 0.001 and P = 0.016, respectively). On multivariate analysis only a lesion size of ≤12 mm predicted the absence of SIL/CIN (odds ratio, OR 10.6; 95% confidence interval, 95% CI 3.6-30.6; P < 0.001). A lesion size of ≤12 mm had a specificity of 90.9% (95% CI 83.0-95.3%) and a negative predictive value of 86.0% (95% CI 77.5-91.6%) to predict the absence of SIL/CIN in the surgical specimen.

CONCLUSIONS

Small lesion size in diagnostic colposcopy could predict the absence of SIL/CIN in the LLETZ specimen. Colposcopy measurement of lesion size prior to LLETZ may avoid unnecessary treatment.

TWEETABLE ABSTRACT

Small lesion size in colposcopic evaluation might predict the absence of SIL/CIN in an LLETZ specimen.

摘要

目的

评估在诊断时阴道镜下病变大小的测量和/或人乳头瘤病毒（HPV）基因分型是否可以预测接受宫颈转化区环形电切术（LLETZ）治疗的鳞状上皮内病变/宫颈上皮内瘤变（SIL/CIN）患者的 LLETZ 标本中无发育不良。

设计

前瞻性观察性研究。

地点

三级大学医院。

人群

一组 116 名因活检证实的低级别 SIL/CIN 持续 2 年而接受 LLETZ 的女性，或因转诊时诊断的高级别 SIL/CIN 和完全可见的鳞柱状交界（根据国际宫颈病理和阴道镜学会，IFCPC，分为 1 型或 2 型）。

方法

LLETZ 后，根据组织学将女性分为研究组（手术标本无 SIL/CIN，28/116，24.1%）和对照组（LLETZ 标本有 SIL/CIN，88/116，75.9%）。

主要观察指标

评估所有女性在诊断性阴道镜检查中的病变大小和 HPV 基因型。

结果

研究组的病变大小明显较小（25.7 ± 37.8 与 84.5 ± 81.7 mm；P < 0.001）。病变大小≤12 mm 和 HPV 类型不是 16 或 18 与 LLETZ 标本中无 SIL/CIN 相关（P < 0.001 和 P = 0.016）。多变量分析仅显示病变大小≤12 mm 可预测 SIL/CIN 缺失（比值比，OR 10.6；95%置信区间，95%CI 3.6-30.6；P < 0.001）。病变大小≤12 mm 的特异性为 90.9%（95%CI 83.0-95.3%），阴性预测值为 86.0%（95%CI 77.5-91.6%），可预测手术标本中无 SIL/CIN。