Does the “Risk-based Management Model” for Residual Disease in Patients with High-grade Cervical Intraepithelial Lesions Cause Overtreatment? Yüksek Dereceli Servikal İntraepitelyal Lezyonları Olan Hastalarda Rezidüel Hastalık için “Risk Bazlı Yönetim Modeli” Aşırı Tedaviye Neden Olur mu?
Medical Journal of Bakirkoy, cilt.18, sa.3, ss.278-284, 2022 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 18 Sayı: 3
- Basım Tarihi: 2022
- Doi Numarası: 10.4274/bmj.galenos.2022.2022.2-20
- Dergi Adı: Medical Journal of Bakirkoy
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CINAHL, EMBASE
- Sayfa Sayıları: ss.278-284
- Anahtar Kelimeler: Cervical intraepithelial neoplasia, human papilloma virus, residuel disease
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: This study aimed to determine the residual disease status of high-grade cervical intraepithelial lesion-positive (HSIL) patients with margin positive at first cervical excision. Methods: This study included patients with HSIL-positive surgical margins following cervical excision procedures between March 2015 and August 2020. The patients with normal histopathology results, cervical intraepithelial neoplasia (CIN)1, CIN2-3 with negative surgical margins, and confirmed cervical malignancy were excluded. HSIL in the second cervical excision pathology was accepted as a residual disease. Demographic and clinical characteristics, pathology results and human papilloma virus genotypes of the patients were assessed. Results: Surgical margin was positive in 354 (21.3%) of 1,656 patients who underwent cervical excision procedures with the indication of HSIL. Computer-based medical records of 330 patients who underwent the second cervical excision procedure from these patients were reviewed and analyzed. Residual disease was diagnosed in 31.3% (31/99) patients whose first cervical biopsy was CIN2 and in 48.4% (112/231) patients with CIN3. Additionally, 3 of the patients with CIN3 had microinvasive cervical cancer in final pathology. In patients with residual disease (≥ CIN2), the rate of CIN3 at first excision, the rate of smokers, and the rate of glandular involvement in the excision specimen was higher (respectively; p=0.04, p=0.01, p=0.03). Conclusion: Residual disease high in patients with the first cervical excision histopathology of CIN3, endocervical glandular involvement, and previously or currently smoked. In the disease management of women with CIN3 and positive margins, re-excision rather than follow-up may be a better option.