Impact of Intraoperative Ultrasound-Guided Loop Electrosurgical Excision Procedure With Individualized Marking on Perioperative Stress Responses, Immune Parameters, and Clinical Outcomes: A Comparative Study With Conventional Surgery.

We assessed the relation between clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) and absence of residual disease, in women diagnosed with cervical cancer (CC) and adenocarcinoma in situ (AIS). Data were collected from 92 women diagnosed with CC and AIS who were positive to HR-HPV and had a repeat cervical HPV test 3-12 weeks after LLETZ (in which CC/AIS were diagnosed) and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV after LLETZ. The HR-HPV results after the LLETZ operation were negative in 40 women and positive in 52 women. The HR-HPV-negative group included a significantly higher incidence of AIS: 14 (35%) vs 5 (9.6%, p < .006).In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among 34 women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p < .0005). The positive predictive value for absence of residual cancer, with clearance of HR-HPV after LLETZ, was 95%. Clearance of HR-HPV from the cervix a short time after LLETZ has a high association with the absence of residual cancer in the final outcome, either in the pathology or the follow-up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.

Objective To compare the clearance rate of high-risk human papillomavirus (HR-HPV) in patients with a high-grade squamous intraepithelial lesion (HSIL) 12 months after focused ultrasound (FUS) or loop electrosurgical excision procedure (LEEP), and analyze the influencing factors. Methods A retrospective cohort was established in HSIL patients with HR-HPV infection treated with FUS or LEEP from 2015 to 2019. The cohort consisted of 321 patients under 30 years of age, of which 119 patients received FUS and 202 patients received LEEP. The Cox regression model was used to identify the influencing factors for HR-HPV clearance. Kaplan–Meier method was applied to estimate the efficacy of FUS and LEEP in HR-HPV clearance, and the log-rank test was used to compare the efficacy difference between FUS and LEEP. Results Multivariate Cox regression analysis showed that both FUS and LEEP were independent influencing factors for HR-HPV clearance. HR-HPV cleared faster in the FUS group than in the LEEP group [the median time to HR-HPV clearance: 6 months in the FUS group (95% CI: 5.492–6.508) and 6 months in the LEEP group (95% CI: 5.734–6.266), p = 0.021]. The HR-HPV clearance rates at 6 and 12 months were 54.6% and 94.1% respectively in the FUS group, and 50.5% and 79. 2%, respectively in the LEEP group (p = 0.001 at 6 months, p = 0.000 at 12 months). Conclusions For HPV-positive HSIL patients under 30, FUS had a better HR-HPV clearance effect than LEEP 1 year after treatment. FUS may be a viable modality for the treatment of young HSIL patients.

<h3>Introduction/Background*</h3> About 40% of CC are in women under age 40 years, for whom fertility-sparing treatment might be very important and should always be considered. More than half the patients who undergo radical surgery (trachelectomy or hysterectomy) have no remnant tumor in the final pathology specimen. HPV clearance is a test of cure after conisation, but it is not a test of cure in CC. Our objective was to assess correlation of clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) with absence of residual disease, in women diagnosed with cervical cancer (CC) and Adenocarcinoma in Situ (AIS). <h3>Methodology</h3> Data was collected from 92 women diagnosed with CC and AIS who were positive to High –Risk HPV (HR-HPV), and had a repeat cervical HPV test 3-12 weeks post-LLETZ, and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV post-LLETZ. <h3>Result(s)*</h3> The pathological results of women who were HR-HPV negative (n=40) compared to HR-HPV positive (n=52) at the post-LLETZ follow-up visit included a significantly higher incidence of AIS: 14 (35%) vs 5(9.6%) (p&lt; 0.006). In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p&lt;0.0005). The negative predictive value for residual cancer, with clearance of HR-HPV after LLETZ was 95%. <h3>Conclusion*</h3> Clearance of HR-HPV from the cervix a short time after LLETZ has a high correlation with the absence of residual cancer in the final outcome, either in the pathology or the follow up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.

Objective To evaluate the effect of paiteling on outcome of high-risk human papillomavirus (HR-HPV) infection of the cervix.Methods Three hundred and twenty-one patients diagnosed as HR-HPV subclinical infection in Shaoxing People's Hospital from January 2011 to June 2013 were selected in the study.The patients were divided into loop electrosurgical excision procedure group (LEEP group,n=82) and non-LEEP group (n=239) in light of the cervical intraepithelial neoplasia classification.The two groups were subgrouped to paiteling group and control group by using random number table.In LEEP group,42 patients in paiteling and 40 in control subgroups; and in non-LEEP group,109 in paiteling and 130 in control subgroups.Paiteling was used in the cervix according to the instructions.The control subgroup had follow-up observation.All patients underwent TCT and HR-HPV test every 3 months for 1 year.The seroconversion rate of HR-HPV and the regression of cervical lesions were compared between the two subgroups.Results In non-LEEP group,the negative conversion rate of HR-HPV in paiteling subgroup at 6-,9-,and 12-months were 83.9％,89.5％,and 95.2％,respectively,which were higher than those in control subgroups with significant differences (x2=66.996,60.270,19.834,P all ＜ 0.01); the regression rate of cervical lesions in paiteling subgroup at 6-,9-,and 12-months were 84.8％,85.7％,and 91.3％,respectively,which were significantly higher than those in control subgroups (x2=66.799,35.783,32.778,P all ＜0.01).After LEEP therapy,the seroconversion rate of paiteling subgroup at 6-,9-,and 12-months were 83.3％,90.0％ and 95.0％,respectively,higher than those in control subgroups with significant differences (x2=66.996,60.270,19.834,P all ＜0.01),but the regression rate of lesions did not differ between the two subgroups (x2=2.736,0.330,0.034,P all ＞0.05).Conclusions Using paiteling in the cervix can speed up the clearance of HPV infection,shorten the persistence of HPV infection,and accelerate the regression of cervical lesions.Paiteling can promote the clearance of HR-HPV after LEEP therapy. Key words: Papillomavirus infections; Genotypes; Paiteling; Outcome; Clearance rate

BackgroundProbiotics has been shown to be effective in reducing vaginal colonization of pathogenic organisms. The aim of this study was to investigate the influence of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on genital high-risk human papilloma virus (HR-HPV) clearance and quality of cervical smear.MethodsThis was a randomized, double-blinded, placebo-controlled trial. Women with genital HR-HPV infection were randomized into study and control groups. A probiotic or placebo preparation was administered orally (one capsule daily) until negative HR-HPV testing. A cervical smear and HR-HPV tests were performed at the beginning of the study and every 3 months thereafter until a negative result was obtained.ResultsA total of 121 women with genital HR-HPV infection were enrolled (62 in the study group and 59 in the control group). There was no significant difference in HR-HPV clearance rate between the two groups (58.1% vs. 54.2%). The only factor predicting HR-HPV clearance was a lower initial viral load (HR 3.214; 95% CI: 1.398, 7.392; p = 0.006). Twenty-two women had a mildly abnormal initial cervical smear and nine had an unsatisfactory smear. At 6 months follow-up, both mildly abnormal cervical smear and unsatisfactory smear rates had decreased significantly in the study group compared to the control group (p = 0.017 and 0.027).ConclusionsThe application of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 did not influence genital HR-HPV clearance, but may have decreased the rates of mildly abnormal and unsatisfactory cervical smears.Trial registrationClinicaltrials.gov NCT01599416, May, 2012. Retrospectively registered.

Objective To explore the therapeutic effects of human papilloma virus (HPV) test combined with thinprep cytologic test (TCT) on evaluating loop electrosurgical excision procedure (LEEP) and the follow-up of high-grade cervical intraepithelial neoplasia(CIN). Methods From March 2005 to December 2006, 115 patients who subjected to loop electrosurgical excision procedure(LEEP) due to histologically confirmed cervical intraepithelial neoplasia(CIN) Ⅱ/Ⅲ were selected. They were classified into two groups according to the diagnosis, one of which was consisted of patients with cervical intraepithelial neoplasia Ⅱ(CINⅡ group, n=68, 59.13%), the other with cervical intraepithelial neoplasiaⅢ(including carcinoma in situ, CIN Ⅲ group, n=47, 40.87%). The study was according to the ethical standards enacted by the ethics committee and confirmed by the committee. Informed consent was obtained from all participates. All 115 cases who underwent loop excision procedure were followed-up until January 2008. Follow–up visits were consisted of cervical thinprep cytologic test during the following 4~6 months after the operation and hybrid capture Ⅱ (HC2) during the following 6~8 months. A retrospective analysis was performed to study effects and prognosis after loop electrosurgical excision procedure. Results The positive human papilloma virus rate was 95.74% in CIN Ⅲ group which was significantly higher than that in CIN Ⅱ group (73.53%) before loop electrosurgical excision(P 0.05). The sensitivity, specificity, positive predictive value(PPV), negative predictive value of hybrid capture Ⅱ were 66.67%, 98.12%, 57.14%, 98.15%. While the sensitivity, specificity, positive predictive value, negative predictive value of the thinprep cytologic test were 83.33%, 76.15%, 16.13%, 98.81%. Four cases whose hybrid capture Ⅱ and thinprep cytologic test both were positive showed residual or recurrent. Specificity and positive predictive value were significantly higher when two tests were combined. Conclusion Loop electrosurgical excision procedure is an effective way for treating high–grade cervical intraepithelial neoplasia. High risk human papilloma virus may play an important role in the occurrence of high grade cervical intraepithelial neoplasia. Pre–treatment of high risk human papilloma virus testing seems to have no predictive value for the prognosis of patients who undergo loop electrosurgical excision procedure for high–grade cervical intraepithelial neoplasia. High risk human papilloma virus combined with thinprep cytologic test during the post–treatment may be of great importance after loop electrosurgical excision procedure. Key words: cervical intraepithelial neoplasia (CIN); loop electrosurgical excision procedure (LEEP); human papilloma virus (HPV); thinprep cytologic test (TCT)

Objective To investigate the effects of cervical loop electrosurgical excision procedure (LEEP) to fertility and pregnancy outcome of patients with cervical intraepithelial neoplasia (CIN).Methods 20 inpatients of CIN from January 2009 to August 2011 were given the LEEP treatment,as the observation group,while other 20 healthy pregnant women randomly selected within the same period of the pregnancy out-patient hospital treatment without history of gynecological surgery,were observed as the control group,the observed pregnancy rate and pregnancy outcome were examined.Results The pregnancy rate of the observation group of 20 patients was 85％ (17/20),preguancy rate was 90％ (18/20) in the control group,there was no significant difference (P＞ 0.05).Cesarean section rate of the observation group was significantly higher than that in the control group (P＜0.05),and there was also no significant difference in abortion incidence,incidence of preterm premature,rupture of membranes incidence and the incidence of small for gestational age (SGA) children in two groups(P＞0.05),no neonatal deaths occurred in the patients of two groups.Conclusion LEEP has no significant effect on the fertility of the CIN patients,without increasing the abortion rate,the rate of preterm birth,premature rupture of membranes,and incidence of SGA children. Key words: Loop electrosurgical excision procedure (LEEP); Cervical intraepithelial neoplasia; Fertility; Pregnancy outcome

Objective To investigate the pregnancy outcome of cervical intraepithelial neoplasia (CIN) by loop electrosurgical excision procedure (LEEP), and to analyze the related factors by logistic regression. Methods Seventy-six cases of cervical intraepithelial neoplasia treated in Shanxi Provincial People’s Hospital from February 2015 to January 2018 were selected as the observation group, and 76 healthy pregnant women in the same period were randomly selected as the control group. The delivery mode, pregnancy outcome and related factors of the two groups were observed and analyzed by Logistic regression analysis. Results The cesarean section rate of the observation group (72.4%) was higher than that of the control group (47.4%), the natural childbirth rate of the control group (42.1%) was higher than that of the observation group (18.4%) (P all 0.05). The rate of premature delivery in the control group (5.3%) was lower than that in the observation group (15.8%, P 0.05). The patients with residual cervical canal length > 1 cm and patients with resection volume less than 4 cm3 had better pregnancy outcomes, and the difference was significant (P<0.05). There was close relationship between the resection of tissue volume and the remaining cervical canal length. The longer the length of the uterine cervix was, the lower the risk of bad pregnancy outcome was; the greater the volume of the excised tissue was, the higher the risk of bad pregnancy outcome was. Conclusions The effect of cervix loop electrocution on the pregnancy outcome of cervical intraepithelial neoplasia is less, but it will increase the rate of caesarean section and premature delivery. The volume of tissue and the length of the remaining cervical canal are closely correlated with the outcome of the pregnancy, which can guide the safety of clinical use. Key words: Loop electrosurgical excision procedure; Cervical intraepithelial neoplasia; Pregnancy outcome

Objective: To preliminarily investigate the clinical outcomes of secondary loop electrosurgical excision procedure (LEEP) combined with transcervical resection of endocervical tissue (i.e., second combined surgeries) in patients with positive endocervical margins following the initial LEEP for high-grade squamous intraepithelial lesion (HSIL) or adenocarcinoma in situ (AIS) of the cervix. Methods: Patients who underwent second combined surgeries due to positive endocervical margins after the initial LEEP for cervical HSIL or AIS at Obstetrics and Gynecology Hospital, Fudan University between August 2015 and September 2023 were included. Postoperative cytological examinations, high-risk human papillomavirus (HR-HPV) testing, colposcopic biopsy results, and cervical canal length were followed up to evaluate the clinical efficacy of second combined surgeries. Results: (1) General clinical data: a total of 67 patients were enrolled, including 34 with cervical HSIL (HSIL group) and 33 with AIS (AIS group). In the HSIL group before the time of initial LEEP, the mean age was (41.3±5.3) years, with all patients positive for HR-HPV preoperatively. Preoperative cytology results revealed ≤low-grade squamous intraepithelial lesion (LSIL) in 13 cases and ≥HSIL in 21 cases. The preoperative cervical canal length was (3.71±0.17) cm. Patients in the AIS group before their the first LEEP were at an average age of (39.1±8.7) years old, with preoperative HR-HPV positive. Among them, 16 cases showed preoperative cytological results of ≤LSIL, while 17 cases showed ≥HSIL. The preoperative cervical canal length was (3.64±0.21) cm. (2) Pathological findings and postoperative follow-up of the HSIL group following second combined surgeries:in the HSIL group, the residual rate of HSIL in the endocervical canal tissue (ECT) was 24% (8/34). Out of the 34 HSIL patients, 10 cases (29%, 10/34) remained with positive endocervical margins post-second combined surgeries. Among these 10 patients, 5 cases (5/10) had no lesion detected in ECT, while the remaining 5 cases (5/10) exhibited HSIL in their ECT. Conversely, 24 patients (71%, 24/34) had negative endocervical margins after second combined surgeries. Of these 24 patients, 3 cases (12%, 3/24) were found to have HSIL in ECT, and 21 cases (88%, 21/24) had no lesion in ECT. During follow-ups conducted at 6 and 12 months post-second combined surgeries, the clearance rates of HR-HPV were 91% (31/34) and 100% (34/34), respectively. Notably, among the 29 patients (85%, 29/34) who were followed up for a period of 2 years or longer, all cases maintained a consistently negative HR-HPV status, highlighting the effectiveness of second combined surgeries in achieving long-term HR-HPV clearance (100%, 29/29). (3) Pathological findings and postoperative follow-up of the AIS group following second combined surgeries: the residual rate of AIS in the ECT following second combined surgeries among AIS patients was 15% (5/33). Out of the 33 AIS patients, 11 cases (33%, 11/33) had positive endocervical margins post-operation, among whom AIS was detected in the ECT of 2 cases (2/11), while 1 case (1/11) was diagnosed with adenocarcinoma in the cervical canal tissue (subsequently underwent radical surgery and was excluded from this study). In contrast, 22 patients (67%, 22/33) had negative endocervical margins post-operation, with AIS found in the ECT of 2 cases (9%, 2/22) and no lesions detected in the remaining 20 cases (91%, 20/22). Follow-up evaluations conducted at 6 and 12 months postoperatively revealed HR-HPV clearance rates of 91% (29/32) and 97% (31/32), respectively. All 32 (100%, 32/32) AIS patients were followed up for a duration of ≥2 years post-second combined surgeries, during which HR-HPV remained consistently negative. (4) Complications and cervical length following second combined surgeries: neither the HSIL group nor the AIS group experienced significant complications such as hemorrhage, infection or cervical canal adhesion. At the 6-month follow-up, the cervical length of both HSIL and AIS patients exceeded 3 cm. By the 12-month follow-up, the cervical length had recovered to 96.5% and 97.5% when compared to the original length, respectively, for the HSIL and AIS groups. Conclusions: For patients with HSIL or AIS who exhibit positive endocervical margins following the initial LEEP procedure, undergoing second combined surgeries presents as an optimal choice. This surgical intervention guarantees thorough excision of the lesion, and subsequent colposcopic follow-up evaluations consistently demonstrate an absence of residual disease or recurrence. Moreover, it augments the rate of sustained HR-HPV negativity, thereby contributing to more favorable clinical outcomes.

Objective To investigate the high risk factors of cervical adhesion caused by loop electrosurgical excision procedure (LEEP), and to find out the effective measures to prevent cervical adhesion caused by LEEP. Methods From January 2013 to December 2014, a total of 603 cases of menopausal transition and postmenopausal patients who received LEEP treatment in International Peace Maternity & Child Health Hospital of China Welfare Institute with taking cervical adhesion prevention measures after LEEP were enrolled into study group. From January 2003 to December 2012, a total of 10 863 cases of patients who received LEEP treatment in International Peace Maternity & Child Health Hospital of China Welfare Institute without taking cervical adhesion prevention measures after LEEP were enrolled into non-intervention group. According to the different cervical adhesion prevention measures after LEEP in study group: placing intrauterine device (IUD) which was T type ring with tail wire once after the treatment of LEEP or using Hegar cervical dilator for physical cervical dilatation, the menopausal transition and postmenopausal patients in study group were further divided into IUD subgroup (n=144) and physical dilator subgroup (n=459). And in the non-intervention group, the menopausal transition and postmenopausal women were included into control group (n=2 270). The incidence of cervical adhesion caused by LEEP in non-intervention group and the related risk factors of cervical adhesion caused by LEEP were analyzed by retrospective analysis method. By following up the study group, the effects of cervical adhesion intervention measures were analyzed prospectively. The incidences of cervical adhesion caused by LEEP in study group and control group, and the incidences of cervical adhesion caused by LEEP and genital tract infection in IUD subgroup and physical dilator subgroup were statistically compared to evaluate the effects of the cervical adhesion intervention measures. There were no statistical differences between the study group and control group, IUD subgroup and physical dilator subgroup in the basic data such as age, gravidity and parity, ratio of type of disease, mode of delivery and so on (P>0.05). Results ①The incidence of cervical adhesion caused by LEEP in non-intervention group was 9.6% (1 042/10 863). In non-intervention group, the incidences of cervical adhesion caused by LEEP in the patients with menopausal transition and menopause, previous cesarean section delivery and conization depth >10 mm were obviously higher than those in the patients with mature period, the previous vaginal delivery, conization depth 0.05). ②The incidence of cervical adhesion caused by LEEP in study group was 10.6% (64/603), which was significantly lower than that in control group (43.8%, 995/2 270), and the difference was statistically significant (χ2=225.90, P<0.001). The incidences of cervical adhesion caused by LEEP in IUD subgroup and physical dilator subgroup were 18.1% (26/144) and 8.3% (38/459), respectively, and they were both obviously lower than that in control group, and both the differences were statistically significant (χ2=36.87, P<0.001; χ2=205.16, P<0.001). The incidences of cervical adhesion caused by LEEP in physical dilator subgroup was obviously lower than that in IUD subgroup, and the difference was statistically significant (χ2=11.04, P<0.001). ③In IUD subgroup, the expulsion rate of IUD was 41.0% (59/144). The genital tract infection rate in IUD subgroup was 24.3% (35/144), which was significantly higher than that in physical expansion subgroup (8.5%, 39/459), and the difference was statistically significant (χ2=25.45, P<0.001). Conclusions The three high risk factors of cervical adhesion caused by LEEP are menopause, delivery mode and conization depth. Both IUD and Hegar cervical dilator can significantly reduce the incidence of cervical adhesion caused by LEEP, but physical dilator method is better and more effective than IUD, and IUD is easy to fall off and the genital tract infection rate is higher than physical dilator method, so physical dilatation of the cervix is a more economical and effective method for the prevention of cervical adhesion after LEEP. Key words: Cervix uteri; Cervical intraepithelial neoplasia; Loop electrosurgical excision procedure; Cervical adhesion; Program evaluation

Background: The factors associated with high-risk human papillomavirus (HR-HPV) clearance and its regulation following conization of cervical HPV-associated lesions remain unclear. Methods: Information was extracted on patients who underwent cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP) at the Affiliated Hospital of Qingdao University and Zhucheng People’s Hospital between September 2014 and September 2020. We compared postoperative HR-HPV clearance between the CKC and LEEP groups using Kaplan-Meier (K-M) curves and calculated the restricted mean survival time (RMST) for each group. Subsequently, we employed univariate and multivariate logistic regression analyses to determine independent prognostic factors. Results: In total, 339 patients were enrolled, including 182 patients who underwent CKC (53.7%) and 157 patients who underwent LEEP (46.3%). The HPV16/18 regression rates were 92.2% and 85.7% in the CKC and LEEP groups, respectively. Patients who underwent LEEP experienced a longer HR-HPV regression period than those who underwent CKC, along with significantly lower regression rates [hazard ratio (HR): 0.795; 95% confidence interval (CI): 0.223–0.974; p = 0.049]. The RMST of HR-HPV positivity after surgery was 5.23 months in the CKC group and 5.79 months in the LEEP group (p = 0.463). Multivariable analysis identified LEEP as an independent risk factor for persistent positive HR-HPV after surgery (odds ratio (OR): 5.730; 95% CI: 1.236–26.568; p = 0.026). Conclusions: CKC is associated with faster, more complete clearance of HR-HPV compared with LEEP. Procedure selection should prioritize adequate excision while preserving healthy tissue. Nonetheless, prospective, standardized studies are needed to confirm these findings.

Objective To discuss the predicting value of cervical intraepithelial neoplasias (CIN) Ⅰ with type Ⅲ transformation zone (TZ) had high grade cervical lesion. Methods From January 2007 and October 2009, 79 cases who were diagnosed as cervical intraepithelial neoplasias Ⅰ by histopathology in the People's Hospital of Jiangsu Province were recruited into this study. The cervical cytological examination showed ≥atypical squamous cell of undetermined significance (ASCUS), and high-risk human papilloma virus(HR-HPV) is positive. The histopathology was conducted after the loop electrosurgical excision procedure (LEEP), and histopathology changes were compared between colposcopic site-specific biopsies and loop electrosurgical excision procedure. Histopathological correlation were compared among preoperational cervical cytology, high-risk human papilloma virus load and loop electrosurgical excision procedure. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of People's Hospital of Jiangsu Province. Informed consent was obtained from all participants. Results ①For 79 cases, 53.16%(42/79, 53.16%) cervical intraepithelial neoplasias Ⅰ was graded up after loop electrosurgical excision procedure with 22 cervical intraepithelial neoplasias Ⅱ, 18 cervical intraepithelial neoplasias Ⅲ and 2 cervical cancer ⅠA1. ②The cytology positively correlated with the grade of cervical lesion (P 0.05). Conclusion Cervical intraepithelial neoplasias Ⅰ with type Ⅲtransformation zone is prone to omission of high-grade intraepithelial lesion. The cytology may help to predict the grade of cervical lesion. But the predicting value of high-risk human papilloma virus on the grade of cervical lesion may be inadequate. Key words: cervical intraepithelial neoplasias (CIN) Ⅰ; type Ⅲ transformation zone; high-risk human papilloma virus(HR-HPV); cytology

ObjectiveTo evaluate the efficacy of loop electrosurgical excision procedure (LEEP) combined with cold coagulation for treating cervical intraepithelial neoplasia (CIN).MethodsWe reviewed clinic-pathologic data of 498 patients treated with LEEP alone (n=354), and LEEP combined with cold coagulation (n=144) between January 2000 and December 2011. After LEEP, we followed up all patients by using Papanicolaou smear and human papillomavirus (HPV) test, and evaluated abnormal cervical cytology-free interval and high-risk HPV infection-free interval. Moreover, we investigated independent factors affecting abnormal cervical cytology or high-risk HPV infection after LEEP.ResultsAbnormal cervical cytology-free interval was longer in patients treated with LEEP combined with cold coagulation than in those treated with LEEP alone (mean, 92.4 vs. 84.4 months; P=0.01), and patients treated with LEEP combined with cold coagulation also showed longer high-risk HPV infection-free interval than those treated with LEEP alone (mean, 87.6 vs. 59.1 months; P=0.01). Moreover, CIN 3 and cold coagulation were factors affecting abnormal cervical cytology after LEEP (adjusted hazard ratios, 1.90 and 0.61; 95% confidence intervals, 1.27 to 2.84 and 0.39 to 0.96), and CIN 3, positive deep cervical margin and cold coagulation were also factors affecting high-risk HPV infection after LEEP (adjusted hazard ratios, 2.07, 4.11, and 0.64; 95% confidence intervals, 1.38 to 3.08, 1.63 to 10.39, and 0.43 to 0.96). When we performed subgroup analyses for patients with CIN 2 or CIN 3, the result were similar.ConclusionLEEP combined with cold coagulation may be more effective for treating CIN than LEEP alone. Moreover, cold coagulation may decrease the risk of potential of recurrence after LEEP.

A comparative study of treatment of cervical low-grade squamous intraepithelial lesions (LSIL)

Objective: To estimate risks of cervical intraepithelial neoplasia (CIN) Ⅱ or worse (CINⅡ+) on loop electrosurgical excisional procedure (LEEP) specimens with the diagnosis of endocervical curettage (ECC) CINⅠ compared with biopsy CINⅠ, and also to investigate the hierarchical management scheme of ECC CINⅠ based on the relevant factors of CINⅡ+ risk. Methods: (1) A retrospective computer-based research for subjects enrolled in the Obstetrics and Gynecology Hospital, Fudan University from Jan. 2013 to Jun. 2021 was performed. The case group comprised women with an ECC CINⅠ (ECC results of CINⅠ with colposcopy-directed biopsy results ≤CINⅠ), and the control group comprised women with a biopsy CINⅠ (colposcopy-directed biopsy results of CINⅠ with negative ECC findings) were divided after LEEP surgery and diagnosis in the next three months. The clinical data of all patients before LEEP were analyzed, and the pathological diagnosis between two groups after LEEP was compared. (2) Variables, including age, cytology, high-risk human papillomavirus (HR-HPV), ECC results, cervical transformation zone (TZ) and colposcopy impression, were included to describe the characteristics and compare the incidence of LEEP CINⅡ+. (3) Univariate analysis and Multivariate logistic regression method were used to analyze the related factors that affect the LEEP CINⅡ+ in CINⅠ patients. Further, the specific risks caused by related factors and conduct a stratified study in LEEP CINⅡ+ were analyzed. Results: (1) Overall, 2 581 women with ECC CINⅠ or biopsy CINⅠ diagnosis who underwent LEEP participated in the study with the mean age (43.6±9.5) years old. Chi square test found that the age and cytology of patients in ECC CINⅠ group were statistically different from those of biopsy CINⅠ group (all P<0.05). There was no significant difference in HR-HPV detection, TZ type and colposcopy impression between the two groups (all P>0.05). ECC CINⅠ comprised 957 women, with LEEP histopathology results revealing 288 (30.1%, 288/957) CINⅡ+, which was significantly higher than that of biopsy CINⅠ which was comprised 1 624 women, with LEEP histopathology results showing 333 (20.5%, 333/1 624) CINⅡ+ (χ2=30.31, P<0.001). (2) Compared by LEEP CINⅡ+ with LEEP ≤CINⅠ group, there were no significant difference in the age, HR-HPV, colposcopy impression (all P>0.05); but there were significantly differences in cytology, ECC CINⅠ, type Ⅲ TZ (all P<0.001). Multivariate logistic regression analysis showed that atypical squamous epithelial cells (ASC-H; OR=2.77, 95%CI: 2.04-3.77), high-grade squamous intraepithelial lesions and worse (HSIL+; OR=2.93, 95%CI: 2.24-3.81), ECC CINⅠ (OR=1.89, 95%CI: 1.56-2.29) and type Ⅲ of TZ (OR=1.76, 95%CI: 1.45-2.11) were independent risk factors for LEEP CINⅡ+ (all P<0.05). (3) When cytology was ≤low-grade squamous intraepithelial lesion (LSIL) and ≥ASC-H, the detection rate of CINⅡ+ in ECC CINⅠ was significantly higher than that of biopsy CINⅠ (all P<0.001). In ECC CINⅠ, the rate of CINⅡ+ with cytology ≤LSIL was significantly lower than that in cytology ≥ASC-H (56.0% vs 25.9%; χ2=49.38, P<0.001). In type Ⅰ/Ⅱ of TZ, the detection rate of CINⅡ+ between ECC CINⅠand biopsy CINⅠ had no significantly different; while in type Ⅲ of TZ, there was significantly different (72.7% vs 46.2%; χ2=4.02, P=0.045). In ECC CINⅠ, type Ⅲof TZ was significantly higher in the rate of CINⅡ+ than that of type Ⅰ/Ⅱ of TZ (72.7% vs 21.7%; χ2=16.38, P<0.001). When cytology ≥ASC-H, type Ⅲ of TZ and colposcopy impression of HSIL were combined, the rate of CINⅡ+ in ECC CINⅠ was 6/6 while 1/3 in biopsy CINⅠ. Conclusions: Cytology ≥ASC-H, ECC CINⅠ and type Ⅲ TZ are the risk factors of LEEP CINⅡ+. However, cytology ≥ASC-H is more valuable in predicting LEEP CINⅡ+ than ECC CINⅠ. For patients with ECC CINⅠ to perform LEEP, it is recommended that cytology ≥ASC-H is taken as the first level stratification, and type Ⅲ TZ is taken as the second level stratification. The colposcopy impression of patients is recommended for a reference parameter.