电圈切除术治疗重度宫颈上皮内瘤变的价值及随访

Value of loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia and HPV DNA test and cytology in detection of residual or recurrent following LEEP

目的评价电圈切除术(LEEP)治疗重度宫颈上皮内瘤变(CINⅡ-Ⅲ)的疗效及液基细胞学(TCT)和高危型人乳头状瘤病毒(HPV)在术后随访中的价值。方法72例阴道镜下活检病理诊断为CINⅡ-Ⅲ患者采用LEEP治疗,术后每半年随访,包括TCT、HPV和阴道镜。有阴道镜异常或细胞学高度病变(HSIL)者行活检,病理证实为CINⅡ-Ⅲ视为病变残留或复发,计算治愈率及TCT和HPV在检测残留和复发中的灵敏度,特异度,阳性预测价值(PPV),阴性预测价值(NPV)。结果LEEP治疗患者治愈率93.05%,9(12.5%)例复发或残留。第一次随访中,HC2(第2代杂交捕获法检测HPV-DNA)和TCT作为独立试验检测残留或复发CINⅡ-Ⅲ级,灵敏度相近,达100%;第2、三次随访中,TCT在特异度和PPV高于HC2,两者均有较高的灵敏度和NPV;两者联合,特异度和PPV显著提高。结论LEEP治疗CINⅡ-Ⅲ安全有效,简便。细胞学和高危型HPV检测术后复发或残留有重要价值。

Objective To determine the value of loop electrosurgical excision procedure （LEEP） for cervical intraepithelial neoplasia （CIN） 2/3 and to compare the performance of TCT and HC2 in detection of residual or recurrent disease. Methods A series of 72 women subjetted to LEEP due to histologically confirmed CIN 2/3 were followed - up biannually consisted of TCT, HPV, and colposcopy. Presence of histologically confirmed CIN 2/3 or higher was considered as residual or recurrent disease. Performance indicators were calculated for cytology and HCⅡ assay in detecting residual or recurrent disease. Results The overall cure rate was 93.05 %. Nine（ 12.5 % ） women showed residual or recurrent disease. Considering HCⅡ and TCT as standalone tests, both techniques showed similar sensitivity at the first follow- up visit. At the second and third, TCT showed better specificity and PPV than HC Ⅱ, and both tests had fairly the same high NPV and sensitivity. While they combined, Specificity and PPV were significantly higher. Conclusion LEEP is a kind of effective and safe methyl for treatment of high - grade CIN, Both TCF and HPV- DNA tests performed well in detecting residual or recurrent disease after LEEP.