Risk Factor Analysis of Persistent High-Grade Squamous Intraepithelial Lesion After Loop Electrosurgical Excision Procedure Conization
Risk Factor Analysis of Persistent High-Grade Squamous Intraepithelial Lesion After Loop Electrosurgical Excision Procedure Conization
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DOI：
10.1097/lgt.0000000000000444
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发表时间：
2019-01-01
影响因子：
3.7
通讯作者：
Sui, Long
中科院分区：
文献类型：
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作者：
Chen, Limei;Liu, Li;Sui, Long
目的分析高频电环切除术(LEEP)术后6个月高度鳞状上皮内病变(HSIL)的临床转归。探讨LEEP术后持续性宫颈HSIL的危险因素，并对随访方法进行评价。患者和方法：这项回顾性研究包括2011至2015年间接受LEEP并在其LEEP标本中诊断为HSIL的妇女。目的是在6个月的随访中确定这些妇女患上持续性HSIL病的危险因素。在她们的随访中，每个妇女都接受了宫颈细胞学和高危人乳头瘤病毒(HrHPV)检测，阴道镜引导下穿孔活检，和/或宫颈内刮除。结果共纳入3582名女性研究对象。发现浸润性宫颈癌9例，持续性HSIL 101例。在50岁或以上的女性中，持久率更高。持续性组和非持续性组LEEP标本的周长和宽度在统计学上没有差异。LEEP标本切缘阳性的女性的持续率高于切缘阴性的女性。宫颈内切缘阳性与宫颈外切缘阳性相比有更高的持续率。多因素Logistic分析显示，年龄、切缘阳性、细胞学异常和随访期间hrHPV阳性都是持续性HSIL病变的独立危险因素。结论年龄大于或等于50岁、切缘阳性，尤其是宫颈切缘阳性、细胞学异常、随访期间hrHPV检测阳性是LEEP锥切术后HSIL持续性病变的危险因素。阴道镜在持续性HSIL的诊断和进展中起着不可或缺的作用。
Objective The aim of the study was to analyze the clinical outcomes of high-grade squamous intraepithelial lesion (HSIL) 6 months after loop electrosurgical excision procedure (LEEP). We explored the risk factors of persistent cervical HSIL after LEEP and evaluated the methods of follow-up. Patients and Methods This retrospective study included women who underwent a LEEP and had a diagnosis of HSIL in their LEEP specimen during 2011 to 2015. The purpose was to determine the risk factors among these women for having persistent HSIL disease at their 6-month follow-up visit. At their follow-up visit, each woman underwent cervical cytology and high-risk human papilloma virus (hrHPV) testing, colposcopy-directed punch biopsy, and/or endocervical curettage. Results A total of 3582 women were enrolled. There were 9 cases invasive cervical cancer found and 101 women had persistent HSIL. The persistence rate was higher in women 50 years or older. The circumference, length, and width of LEEP specimens did not differ statistically between the persistent and nonpersistent group. The persistence rate among women with positive LEEP specimen margins was higher than among women with negative margins. Positive endocervical margins were associated with a higher rate of persistence than positive ectocervical margins. Multivariate logistic analysis showed that age, positive margins, abnormal cytology, and positive hrHPV during follow-up were all independent risk factors for persistent HSIL lesions. Conclusions Being 50 years or older, positive margins, particularly endocervical margins, and having abnormal cytology and positive hrHPV testing during follow-up were risk factors for persistent HSIL lesions after LEEP conization. Colposcopy plays an indispensable role in the diagnosis of persistent HSIL and progression.