Diagnostic Accuracy of Colposcopically Directed Biopsy and Loop Electrosurgical Excision Procedure for Cervical Lesions

Objective:The aim of this study is to evaluate the diagnostic accuracy of colposcopically directed biopsy(CDB)and loop electrosurgical excision procedure(LEEP)for cervical lesions and assess their ability to detect glandular involvement.Methods:This retrospective study reviewed 4689 cervical lesions that were tested by CDB and LEEP at a tertiary hospital.The sensitivity,specificity,and predictive value of CDB and LEEP and the ratio of glandular involvement detected by these two methods were analyzed.Results:CDB and LEEP had sensitivities of 95.4%and 80.0%,respectively,for diagnosing high-grade intraepithelial or more severe lesions(HSIL+)(P=0.000)and 31.8%and 87.9%,respectively,for diagnosing adenocarcinoma in situ or more severe lesions(AIS+)(P=0.001).CDB and LEEP had sensitivities of 18.1%and 90.2%,respectively,for diagnosing invasive squamous cell carcinoma(P=0.000)and 5.9%and 98.0%,respectively,for diagnosing invasive adenocarcinoma(P=0.000).The negative predictive values of CDB and LEEP for diagnosing HSIL+were 88.6%and 64.4%,respectively(P=0.000).The ratios of glandular involvement were 0.2%(CDB)and 2.4%(LEEP)in low-grade intraepithelial lesions(LSILs)and 8.9%(CDB)and 59.0%(LEEP)(P=0.000)in HSIL+.Conclusions:LEEP is superior to CDB for diagnosing AIS and detecting early invasive cancer.It should be offered as an additional investigation to all patients with AIS,HSIL,or LSIL with glandular involvement on CDB.

Comparison of Five Treatment Strategies for Cesarean Scar Pregnancy

Objective:To explore appropriate treatment strategy for cesarean scar pregnancy(CSP)in the first and second trimester.Methods:Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed.Treatment strategies were as follows:Group A(n=102),uterine artery chemoembolization(UACE)followed by dilation and curettage(D&C);Group B(n=63),D&C;Group C(n=6),hysteroscopy;Group D(n=6),laparotomy;and Group E(n=5),laparoscopy.The basic clinical findings were collected and analyzed,along with the curative effects.Results:The preoperative serum beta-human chorionic gonadotropin(β-HCG)level was in the order of Group D,A>B,C>E(P=0.001);the size of gestational sac(GS)was in the order of Group D,E>A,C>B(P=0.000);and the thickness of the anterior myometrium was in the order of Group B>A,C>D,E(P=0.000).Three cases in the second trimester were all in Group D;two cases were treated with UACE before laparotomy with moderate blood loss(100 and 200 mL,respectively)and the third case was initially treated with D&C and had severe hemorrhage.Conclusions:The diameter of GS,thickness of the anterior myometrium,and preoperativeβ-HCG level are important factors for the choice of treatment.UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester.For Type 2 CSP cases in the second trimester,UACE before laparotomy could be a reasonable choice.