Results of thin-layer cytology and biopsy and the risk factors for residual and/or recurrence after loop elec-trosurgical excision procedure for cervical intraepithelial neoplastic lesions / 医学研究生学报

ABSTRACT

Objective The loop electrosurgical excision procedure (LEEP) is a major option for the treatment of cervical in-traepithelial neoplastic (CIN) lesions,but reports are rarely seen on the consistency of the result of post-LEEP pathology with that of preoperative biopsy as well as on the postoperative pathological upgrading of related factors. This study analyzes the consistency of the result of preoperative biopsy with that of post-LEEP pathology for CIN lesions and the risk factors for residual and/or recurrence after LEEP. Methods A retrospective study was conducted on 1 089 patients with CIN lesions treated by LEEP in our hospital from May 2014 to A-pril 2017. All the patients underwent liquid-based thin-layer cytology (TCT) and vaginoscopic biopsy preoperatively,followed by analysis of the results of TCT,the consistency of the result of preoperative bi-opsy with that of post-LEEP pathology,and the risk factors for residu- al and/or recurrence after LEEP. Results Preoperative biopsy showed 447 cases of low-grade squamous intraepithelial lesion (LSIL),among which TCT revealed 85 cases negative for intraepithelial lesion and malignancy (NILM),with a false negative rate of LSIL of 19.0%. Of the 645 cases of high-grade squamous intraepithelial lesion (HSIL) revealed by preoperative biopsy,TCT manifes-ted 95 cases of NILM,with a false negative rate of HSIL of 14.7%,which was significantly lower than that of LSIL (P<0.05). Preop-erative biopsy showed 447 cases of LSIL,among which post-LEEP pathology manifested 316 cases of LSIL (70.69%) and 51 cases of HSIL (11.4%). Of the 635 cases of HSIL revealed by preoperative biopsy,post-LEEP pathology exhibited 4 cases (0.63%) of inva-sive cervical cancer (ICC). Multivariate analysis showed the risk factors for pathological upgrading after LEEP were sexual partners >2 (OR=0.139,95% CI 0.034-0.561) and LSIL in TCT (OR=0.111,95% CI 0.040-0.310) (P<0.05) and those for postopera-tive recurrence included positive incision margin (OR=2.970,95% CI 1.010-8.733) and persistent human papilloma virus (HPV) infection (OR=5.446,95% CI 3.109-9.540). Preoperative HPV16 infection was correlated with lesion residual and/or recurrence after LEEP (P<0.05). Conclusion LEEP can significantly improve the diagnosis rate of HSIL in low-grade CIN patients with high risk factors. The risk factors for lesion residual and/or recurrence after LEEP include HPV16 infection,lesion involvement of the inci-sion margin,and persistent HPV infection.