宫颈冷刀锥切治疗宫颈上皮内瘤样病变Ⅲ级的评价

目的 探讨阴道镜下多点活检与宫颈冷刀锥切对于宫颈上皮内瘤样病变Ⅲ级（CINⅢ）病理诊断的符合情况。方法 1995—2005年间对北京大学人民医院92例阴道镜下多点活检病理诊断为CINⅢ的患者进行宫颈冷刀锥切治疗，比较阴道镜下多点活检与宫颈冷刀锥切的病理结果之间的差异。结果 92例中有52例多点活检与冷刀锥切的病理结果一致，符合率为56．5％，40例多点活检与冷刀锥切的结果不同，其中11例多点活检诊断为CINⅡ／Ⅲ，而冷刀锥切诊断为微小浸润癌。结论 宫颈锥切是宫颈上皮内瘤样病变的一种重要诊断与治疗方法。阴道镜下多点活检病理提示宫颈上皮内瘤样病变Ⅲ级并伴随腺体受累可能是存在宫颈浸润癌的一个高危因素。人乳头瘤病毒（HPV）感染与宫颈病变有关，但未发现HPV高危型检测数值高低与患者病理级别之间的联系。     

Residual and recurrent lesions after conization for cervical intraepithelial neoplasia grade 3.

OBJECTIVES: To evaluate the importance of regular and long-term follow-up of patients who had conization for cervical intraepithelial neoplasia grade 3 (CIN 3); and to assess the risk of residual/recurrent lesions of the cervix uteri. METHODS: Retrospective analysis of 934 patients with CIN 3 who underwent conization over the period 1 January 1985-31 December 1997. The analysis included 38 (4.1%) patients who had involved resection margins and 896 (95.9%) patients who had free resection margins. RESULTS: Twenty-three out of 934 (2.5%) patients had another operation (reconization in 17 and hysterectomy in six) whereas one patient had a biopsy. Residual or recurrent lesion after conization was found in 23 patients out of 934 (2.5%). Three patients had invasive cervical cancer (0.3%), 19 had CIN 3 (2.0%) and one patient had CIN 1 (0.1%). One of the 24 patients (4.2%) was diagnosed with no lesion after repeated operation. Eleven patients out of 38 (28.9%) with involved resection margins during the first conization had residual/recurrent disease, compared with eight out of 896 patients (0.9%) who had free resection margins. CONCLUSION: Another operation is recommended only in cases when, on the basis of cytological, colposcopical and histological findings, the gynecologist suspect the residual/recurrent lesions.     

宫颈锥切术在诊断宫颈上皮内瘤样病变和早期宫颈癌中的价值

目的探讨宫颈锥切术能否被阴道镜多点活检所代替以及宫颈锥切术在诊断宫颈上皮内瘤样病变（CIN）和早期宫颈癌中的价值。方法回顾分析近5年来,在江苏大学附属宜兴医院妇产科因宫颈病变同时行阴道镜多点活检和宫颈锥切术（包括冷刀和电圈环切术即LEEP术）的患者120例,采用自身对照法,对比研究宫颈锥切术和阴道镜多点活检的病检结果的差异。结果宫颈锥切术与阴道镜下多点活检病理符合者59例（49．17％）;不符合者61例（50．83％）,宫颈锥切术后病理诊断加重者35例（占29．17％）,浸润癌漏诊率达10．00％。宫颈锥切术的主要并发症为出血。结论宫颈锥切术在诊断CIN和早期宫颈癌具有重要价值,不能被阴道镜多点活检所取代。要重视切缘是否阳性和加强术后的随访。     

子宫颈冷刀锥切术诊治子宫颈上皮内瘤变61例临床分析

目的探讨宫颈冷刀锥切术（CKC）在宫颈上皮内瘤变（CIN）诊治中的价值。方法对2010年1月至2011年10月在北京大学人民医院妇科门诊经阴道镜下活检病理确诊为CIN2／3并行CKC的61例患者的临床资料进行回顾性分析。结果CKC术后与术前阴道镜活检病理级别的符合率为78．7％（48／61）,其中16．4％（10／61）升级,4．9％（3／61）降级。发现宫颈浸润癌8例,切缘阳性2例。结论CKC是一种诊断治疗宫颈上皮内瘤变的简单、安全的方法,可以提高CIN2／3诊断准确率,有助于宫颈浸润癌的早期诊断。     

宫颈上皮内瘤变锥切术后残留或复发相关因素Meta分析

目的 探讨宫颈上皮内瘤变锥切术后残留或复发相关因素。 方法　以宫颈上皮内瘤变、锥切、残留、复发因素的中英文为检索词,检索2006年1月至2013年6月Pubmed、中国知网、万方数据库收录的文献,研究设计类型为病例对照研究或队列研究,提取信息,应用RevMan 5.0软件进行Meta分析。结果　检索到符合纳入标准的文章15篇,随访总例数2721例。Meta分析结果显示：锥切术后残留或复发危险因素为：年龄超过50岁（OR =3.67,95%CI 2.44 ～5.52）、切缘阳性（OR=4.43,95%CI 3.42 ～5.75）、腺体累及（OR=4.54,95%CI 2.22 ～9.30）、术前人乳头瘤病毒高负荷（OR=6.51,95%CI 4.32 ～9.81）、术后高危人乳头瘤病毒持续阳性（OR=33.39,95%CI 16.86 ～66.14）、人类免疫缺陷病毒（HIV）感染（OR=5.60,95%CI 3.10 ～10.11）、绝经（OR=2.32,95%CI 1.35 ～3.99）;而吸烟（OR＝1.37,95%CI 0.75 ～2.51）是锥切术后残留或复发的相关因素尚无统计学意义。结论　年龄≥50岁、切缘阳性、腺体累及、术前高危人乳头瘤病毒高负荷、术后高危人乳头瘤病毒持续阳性、HIV感染和绝经是锥切术后病灶残留或复发的危险因素,而吸烟不是锥切术后病灶残留或复发的危险因素。     

Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia

Objective

To investigate the risk factors potentially associated with high-risk human papillomavirus (HPV) persistence in women undergoing cold-knife conization (CKC) for treatment of high-grade cervical intraepithelial neoplasia (CIN).

Methods

Medical records of women who underwent CKC for treatment of CIN 2/3 between 2007 and 2012 at a tertiary hospital in Ankara, Turkey, were retrospectively analyzed. Cases involving persistent HPV infection after 1 year of follow-up were identified. Using univariate and multivariate analyses, the impact of various factors such as patient age, menopausal status, parity, high-risk HPV type, excised cone dimensions (width, height, and depth), and surgical margin status on high-risk HPV persistence was assessed.

Results

A total of 292 women underwent CKC for treatment of CIN 2/3 within the study period. After women with a subsequent diagnosis of cervical cancer, subsequent total hysterectomy, and inadequate follow-up data were eliminated, 113 women were eligible for final analysis. High-risk HPV persistence was detected in 24 (21.2%) women, and multivariate analysis revealed that patient age and cone depth were significant independent predictors (P < 0.05).

Conclusion

High-risk HPV persistence may be encountered after CKC procedures. It is important to evaluate persistent HPV infections after treatment because affected women are at increased risk for disease persistence, recurrence, and progression.     

Angiogenesis in cervical intraepithelial neoplasia and early-staged uterine cervical squamous cell carcinoma: clinical significance

The objective of this study is to evaluate angiogenesis in cervical intraepithelial neoplasia (CIN), microinvasive squamous cell carcinoma (MIC), and early-staged squamous cell carcinoma (SCC), stage IB-IIA of the cervix. Microvessel density (MVD) was evaluated and correlated with other pathologic prognostic factors and disease outcomes. Four hundred seventy-four cervical specimens were studied. Among these, 100 were designated normal cervix, 30 CIN1, 32 CIN2, 178 CIN3, 74 MIC, and 60 early-staged SCC. MVD per high-power field (x400) of early-staged SCC, MIC, and CIN3 were significantly higher in comparison to CIN2, CIN1, and control subjects (P<0.05). There was no statistically significant difference in MVD between control group, CIN1, and CIN2. In early-staged SCC, no correlation between MVD and pelvic lymph node status, parametrial involvement, depth of stromal invasion, and lymphovascular space invasion was found. Patients with bad outcomes (recurrence or death) showed no statistically different MVD from the ones who had unremarkable clinical courses.     

The risk of residual neoplasia in women with microinvasive squamous cervical carcinoma and positive cone margins

The objective was to evaluate the prevalence and factors affecting residual disease in women with cervical microinvasive carcinoma (MIC) with positive cone margins for high-grade lesions and invasive carcinoma. We reviewed histopathology slides of 129 women with MIC who had high-grade lesions or invasive carcinoma at cone margins. These patients underwent hysterectomy following cone biopsy between January 1994 and June 2004. Of the 129 patients, 77 (59.7%) had residual disease in the hysterectomy specimens, in which 57 (44.2%) had residual high-grade lesions. Twenty patients (15.5%) had residual invasive carcinoma: 18 were microinvasive and 2 were invasive. Factors significantly affecting the risk of residual disease included positive postconization endocervical curettage (P= 0.001), positive cone margins for invasive carcinoma (P= 0.003), and depth of stromal invasion >1 mm (P= 0.014). Cox proportional hazards analysis revealed positive cone margins for invasive carcinoma as significant predictor of residual invasive disease (hazard ratio, 3.22; 95% CI 1.21-8.60, P= 0.019) In summary, patients with MIC and positive cone margins for high-grade lesions or invasive carcinoma are at high risk of residual neoplasia. Repeat cone biopsy should be performed to determine exactly the severity of lesion before planning treatment.     

Importance of surgical margins in conization for cervical intraepithelial neoplasia grade III

We conducted a retrospective study on 201 conizations for CIN III done over the last 14 years. Of these, 53 (26.4%) had involvement of the margins, 114 (56.7%) had margins free of neoplasia, and 34 (16.9%) were not evaluated. Of the 53 cases with margin involvement, 28 (52.8%) had complementary surgery and 25 (47.2%) cytological follow-up. Residual CIN was identified in the surgical specimen in 15 cases (53.6%) and microinvasion was present in 2 cases (7.1%). Of the 114 patients with margins free of neoplasia in the cone, 12 had a hysterectomy during follow-up for CIN III diagnosed by cytology and biopsy. Seven of these 12 patients (58.3%) had CIN in the surgical specimen and none had microinvasive cancer. Received: August 1998 / Accepted: 3 May 1999     

Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia

Objective

To examine the causal contribution of conization to premature delivery.

Methods

This was a retrospective, case-control, multicenter study of women who underwent conization in 5 hospitals in the Basque Country (Spain) from 1998 to 2007. Three study groups were established: group A, post-conization infant deliveries; control group B, pre-conization infant deliveries; and control group C, infant deliveries without conization.

Results

Comparing group A with group C, there was a higher rate of preterm delivery before 35 weeks (5.3% versus 1.6%), a lower mean birth weight (3156.2 g versus 3328.5 g), and a greater prevalence of infants under 2500 g (10.6% versus 3.7%). There were no significant differences between group A and group B: preterm delivery before 35 weeks (5.3% versus 4.8%), mean birth weight (3156.2 g versus 3119.4 g), and prevalence of infants under 2500 g (10.6% versus 10.6%).

Conclusion

Pregnancy in women post-conization was associated with a risk of preterm delivery. However, there were no significant differences between women who underwent conization before and those who underwent conization after delivery. Cervical conization does not necessarily increase the risk of preterm delivery in subsequent pregnancy. Conization should be considered an indicator of such risk because it is associated with pregnancy complications arising from socio-epidemiologic factors present in women requiring conization that are also present in women who have premature delivery.     

Development of endometrioma after cervical conization

The association between cervical conization and subsequent development of endometriosis is uncertain. The objective of this study was to estimate the incidence rate of ovarian endometrioma after cervical conization and to determine factors associated with the development of endometrioma. One hundred forty-two patients who underwent cervical conization at the University of Tokyo Hospital between January 2006 and December 2013 were included in the study. Their medical records were retrospectively studied until April 2015. The incidence rate of postconization endometrioma was calculated. Patients’ characteristics (age, parity, preoperative and postoperative diagnosis and observation period) were analyzed. Six patients developed endometrioma after the cervical conization, and the incidence rate of endometrioma among patients who underwent cervical conization was 10.8 per 1000 person-year (95%CI 3.6–20.5). Patients’ age, percent of nulliparous, postoperative diagnosis and observation period were not associated with the development of postconization endometrioma. A preoperative diagnosis with invasive cancer (p?相似文献   

Feasibility and outcome of laser CO2 conization performed within the 18th week of gestation

The purpose of this study is to evaluate the feasibility, safety, and potential therapeutic benefit of laser CO(2) conization of the cervix for in situ and minimally invasive carcinoma diagnosed during pregnancy. Twenty-six pregnant patients with biopsy-proven carcinoma in situ/cervical intraepithelial neoplasia III but colposcopically suspicious for invasion underwent laser CO(2) conization during the 18th week of gestation in an outpatient setting under local anesthesia. No major intraoperative or postoperative complications occurred, and cervical cerclage was not required in any case. Two cases (7.7%) of occult FIGO stage IA1 minimally invasive cervical cancers with free surgical margins were diagnosed. Both patients delivered vaginally at term and were free of disease at postpartum follow-up. Median length of gestation was 39.1 weeks with a median birth weight of 3450 g. All 1-min Apgar scores were 8 or greater. Twenty patients (76.9%) delivered vaginally, while six patients underwent cesarean section for indications not related to the prior conization. After a mean postpartum follow-up of 18 months (range 3-42), 92.3% of patients continued to have both cytologic and colposcopic evaluations negative for persistent or recurrent disease. Two cases of persistent intraepithelial disease were successfully managed by reconization. In summary, our data suggest that laser CO(2) conization performed within the 18th week of gestation is safe for both the patient and the fetus, provides reliable histologic diagnosis, and can be curative. Further studies are required to confirm the favorable risk-benefit ratio of laser CO(2) conization in the management of non-reassuring cervical lesions observed in the first half of pregnancy.     

宫颈冷刀锥切术诊治宫颈上皮内瘤变Ⅲ级320例临床分析

目的:探讨宫颈锥切术在宫颈上皮内瘤变Ⅲ级(CINⅢ)的诊断与治疗中的价值。方法:回顾性分析因宫颈CINⅢ行宫颈锥切术的患者320例,采用自身对照法,对比研究宫颈锥切术和阴道镜下活检的病理结果。结果:宫颈锥切术与阴道镜下检查的病理结果完全符合者187例(58.44%),不符合者133例(41.56%)。锥切术后病理诊断级别下降者69例(21.56%),漏诊微小浸润癌60例(Ⅰa1期55例,Ⅰa2期5例)(18.75%),漏诊浸润癌(Ⅰb1期)4例(1.25%)。59例患者再次行子宫切除术,其中32例(54.24%)术后病理转阴,16例病理诊断级别降低。宫颈锥切术的主要并发症是术后出血。结论:宫颈锥切术在CINⅢ的诊断和治疗中具有重要价值。应根据患者年龄、病变程度、切缘状态、生育要求等多方面个体化、综合考虑以决定进一步的治疗方案。     

Prognostic factors in microinvasive cervical squamous cell cancer: long-term results

We examined tumor-related pathologic factors and cone-related characteristics to identify parameters related to recurrence in microinvasive squamous cell carcinoma of the cervix treated with conization. This is a retrospective study on 67 consecutive cases of microinvasive carcinoma of the cervix [depth of invasion (DI) < 3 mm] treated with conization. The mean follow-up was 121 months (range 72-276 months). Four (6%) invasive recurrences were observed. Presence of lymphvascular space involvement (LVSI) was significantly related with recurrences (P < 0.05). The mean distance between tumor margin and apex of the cone (apical clearance) was 10.6 mm (range 5-22 mm), and the mean distance between lateral border of the cone and tumor margin (lateral clearance) was 6.5 mm (range 1.7-15 mm). We adopted cut-off values of 10 and 8 mm for apical and lateral clearances, respectively. We found a statistically significant difference between apical clearance and recurrence rate (P < 0.02). The LVSI was, other than DI, an important prognostic factor. Apical clearance was significantly correlated with recurrence. The cone-related characteristics, other than tumor-related pathologic factors, could help the decision concerning the definitive therapy for microinvasive carcinoma of the cervix.     

宫颈鳞癌和宫颈上皮内瘤变组织中人乳头瘤病毒16型及18型的表达

目的从分子水平探讨宫颈鳞状细胞癌(CSCC)及宫颈上皮内瘤样病变(CIN)组织中人乳头瘤病毒(HPV)16型和18型的表达及临床意义。方法2001年1月至2005年1月在中国医科大学附属第一医院采用原位杂交技术分别检测CSCC60例、CIN60例和20例正常宫颈组织中HPV16型和18型DNA的表达。结果在上述各组织中HPV16型表达阳性率分别为73.3%(44/60)、35.0%(21/60)和10.0%(2/20),均明显高于正常对照组(P<0.01和P<0.05);而HPV18型在各组间表达的阳性率比较差异均无显著性意义(P>0.05)。HPV16型表达与CIN的发展有关,在CINⅠ～Ⅱ和CINⅢ的表达分别为23.7%和54.6%,且差异有显著性意义(P<0.05),而HPV18型表达情况与CIN的发展无关(P>0.05)。HPV16和18型的表达与CSCC分化程度及有无淋巴结转移无关。结论宫颈组织中HPV16型的过度表达与CSCC及CIN的发展密切相关,为阐明宫颈癌病因和发病机制以及预测CIN进一步发展的可能性提供了理论依据。     

Evaluation of cervical conization as a definitive treatment for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3

Purpose  

The aim of the study was to evaluate disease persistence after conization of CIN3 and microinvasive cervical carcinoma.