高度宫颈上皮内瘤变电环切术后复发的预测因素

Predictors for Recurrence of High-grade Cervical Intraepithelial Neoplasia(CIN) after Loop Electrosurgical Excision Procedure(LEEP)

【目的】探讨高度宫颈上皮内瘤变(CINⅡ/Ⅲ)行环形电切除术(LEEP)术后随访的检测方法和复发的危险因素。【方法】回顾性分析2007年1月至2009年1月在我院行LEEP术并且病理诊断为CINⅡ/Ⅲ病例203例。分析术前的液基细胞学(LCT)、高危型HPV DNA,临床病理特征和术后24月随访的LCT、HPV DNA与最终复发的关系。【结果】203例接受LEEP术并保留子宫的患者,在24个月的随访中发现18例复发,复发率为7%。手术病理切缘阳性、宫颈管搔刮阳性与复发相关(P<0.01);术后随访的LCT、高危型HPV DNA预测复发的敏感性、特异度、阳性预测值和阴性预测值分别为72.2%和94.4%、81.6%和86.9%、27.7%和42.5%、97.4%和99.3%,手术前后相同的高危型HPV DNA基因型预测复发的敏感性、特异度、阳性预测值和阴性预测值分别为94.1%、95.7%、94.1%和95.7%。与HR-HPV DNA比较,术前术后相同HR-HPV基因型预测LEEP术后复发的敏感性和阴性预测值相似,而特异度和阳性预测值更高。【结论】手术病理切缘阳性和宫颈管搔刮阳性是LEEP术后复发的危险因素,术后随访除LCT和高危型HPV外,手术前后相同HPV基因型是复发的重要预测因素。

[Objective] To investigate the risk factors connected to recurrence of high-grade cervical intraephethial neoplasia （CIN lI/llI ） after loop electrosurgical procedure （LEEP） and evaluate the methods to follow up. [Methods] Analysis was performed with 203 cases who underwent a LEEP and were pathologically confirmed CIN lI / ]U in the Second Affiliated Hospital, Sun Yat-sen University from January 2007 to January 2009. Preoperative liquid-based cytological tests （LCT）, high-risk HPV DNA （HR-HPV）, clinicopathologic features were analyzed. The cases were followed up as long as 24 months after LEEP. LCT, HPV DNA were performed at the sixth, twelfth, eighteenth, and twenty-forth month after LEEP. Colposcopy and biopsy and endocervical curettage （ECC） were performed in case of either of LCT or HR-HPV DNA was positive. All of the cases who were followed up with negative results in LCT and HPV DNA were performed with colposcopy and biopsy and ECC at the 24th month after LEEP. [ Results ] An analysis of 203 patients who underwent a LEEP and pathologically confirmed CIN /Ⅲ were performed. Eighteen patients were proved recurrence in the period of 24 months of follow-up with a recurrent rate of 7.0%. Margin involved and positive ECC were associated with recurrence （P 〈 0.01 ）. Patients with margin involved had a recurrent rate of 20.8% while those without had a recurrent rate of 4.7%. Patients with positive ECC had a recurrent rate of 29.1% while those without had 4.7%. Sensitivity, specificity, positive predictive value and negative predictive value in follow up LCT and HR-HPV were 72.2% and 94.4%, 81.6% and 86.9%, 27.7% and 42.5%, 97.4% and 99.3%, respectively. In the same HR-HPV genotype pre- and post-procedure, Sensitivity, specificity, positive predictive value and negative predictive value were 94.1%, 95.7%, 94.1%, and 95.7%. Compared with HR-HPV DNA, the same HR-HPV type pre- and post-procedure had the equal sensitivity and negative predictive value but higher specificity and positive predictive value. [Conclusions] Margin involved and positive ECC are risk factors for recurrence after LEEP. Besides LCT and HR- HPV DNA, the same HR-HPV genotype pre- and post-procedure is an important predictive factor for recurrence during follow up.