A Large Retrospective Study of 12714 Cases of LEEP Conization Focusing on Cervical Cancer That Colposcopy-Directed Biopsy Failed to Detect.

Qing Cong,Shujun Gao,Qing Wang,Wenjing Diao,Caiying Zhu,Feng Xie,Jing Dong,Hua Feng,Yu Song,Long Sui,Ming Du,Hongwei Zhang

doi:10.1155/2018/5138232

Abstract

Punch biopsy is important in the diagnosis of cervical cancer. However, it may fail to detect early cervical cancers. A retrospective study was performed in the largest academic women's hospital in China to demonstrate cervical cancer that colposcopy-directed biopsy failed to detect. Methods. Patients who were diagnosed with high-grade squamous intraepithelial lesion (HSIL), adenocarcinoma in situ (AIS), and persistent low-grade squamous intraepithelial lesion (LSIL) via colposcopy-directed biopsy and had further undergone loop electrosurgical excision procedure (LEEP) conization were included. These procedures were performed at Obstetrics and Gynecology Hospital of Fudan University from July 1, 2013, to December 31, 2016. In total, 5.98% (760/12714) of patients who underwent conization were diagnosed with invasive cervical cancer. Persistent LSIL (0.24%), HSIL (6.37%), and AIS (24.31%) were detected cancer by conization. Histological subtypes included squamous cell carcinoma (92.0%), adenocarcinoma (5.1%), adenosquamous carcinoma (1.8%), adenoid basal type carcinoma (0.9%), and small cell neuroendocrine carcinoma (0.1%). Cytology reports consisted of HSIL (45.4%), atypical squamous cells of undetermined significance (ASC-US) (16.1%), and LSIL (11.6%), and atypical squamous cells cannot exclude HSIL (ASC-H) (9.3%), squamous cell carcinoma (0.9%), AGC (atypical glandular cells, 0.9%), AIS (0.4%), and NILM (negative for intraepithelial lesion or malignancy, 15.4%). The sensitivity of high-risk human papillomavirus (hrHPV) screening (96.4%) was significantly higher than that of cytology (84.6%) (P < 0.01), with sensitivity of cotesting at 99.8% and a ratio of double-negative results at 0.2%. The sensitivity of cytology and hrHPV screening of different cervical cancer histologic subtypes was also demonstrated. In this large retrospective study, we systematically reported the cytology, hrHPV, pathology, and stages of cervical cancer that colposcopy-directed biopsy failed to detect.

Highlights

Cervical cytology and high-risk human papillomavirus screening greatly contribute to the early detection of cervical cancer and precancers such as high-grade squamous intraepithelial lesion (HSIL) or cervical intraepithelial neoplasia 2/3 (CIN2/3) [1]
HSIL, adenocarcinoma in situ (AIS), and low-grade squamous intraepithelial lesion (LSIL) diagnosed by punch biopsy were subjected to loop electrosurgical excision procedure (LEEP) conization
By LEEP conization, 0.24% of LSIL, 6.37% of HSIL and 24.31% of AIS diagnosed by punch biopsy were further confirmed as having cervical cancer

Summary

Introduction

Cervical cytology and high-risk human papillomavirus (hrHPV) screening greatly contribute to the early detection of cervical cancer and precancers such as high-grade squamous intraepithelial lesion (HSIL) or cervical intraepithelial neoplasia 2/3 (CIN2/3) [1]. In CIN2/3 detected by punch biopsy, LEEP conization allows further and more accurate histologic examination of the transformation zone [4]. It goes undetected by visual inspection of the naked eye or colposcopy-directed biopsy, unsuspected invasive cancer can be detected by histopathologic examination of conization masses. Loop electrosurgical excision procedure (LEEP) conization, known as large loop excision of the transformation zone (LLETZ), highfrequency-needles, and laser conization are optimal, whereas cold-knife conization is associated with an excessive risk for subsequent obstetric complications [5]

Methods

Results

Conclusion