Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (...Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.展开更多
目的探讨子宫颈环形电切术(LEEP)对宫颈癌前病变的疗效。方法选取200例宫颈上皮内瘤样病变(CIN)患者,均行LEEP治疗,观察并记录患者的手术时间、术中出血量、不同程度CIN患者治愈例数,对比患者术前阴道镜下宫颈活检和LEEP术后病理组织检...目的探讨子宫颈环形电切术(LEEP)对宫颈癌前病变的疗效。方法选取200例宫颈上皮内瘤样病变(CIN)患者,均行LEEP治疗,观察并记录患者的手术时间、术中出血量、不同程度CIN患者治愈例数,对比患者术前阴道镜下宫颈活检和LEEP术后病理组织检查结果,记录随访1个月期间并发症情况。结果患者所需手术时间6~22 min,平均手术时间(7.9±1.8)min;术中出血量16~41 m L,平均术中出血量(21.3±8.9)min。术后病理结果证实:CINⅠ72例患者,全部治愈,治愈率100%,CINⅡ87例患者,治愈81例,治愈率93.1%,CINⅢ41例患者,治愈37例,治愈率90.2%。不同程度CIN患者治愈率相比,无统计学差异(P>0.05)。术前阴道镜宫颈活检与LEEP术后病理诊断结果比较,CINⅠ病理符合率94.1%,CINⅡ病理符合率83.5%,CINⅢ病理符合率74.5%,不同程度CIN的术后病理符合率相比,差异有统计学意义(P<0.05)。随访1个月,6例出现宫颈粘连,3例宫颈管狭窄,下腹坠痛伴烧灼感7例,并发症发生率8%。结论 LEEP对宫颈癌前病变具有较好的治疗与诊断效果,诊断效果好于术前阴道镜宫颈活检,术后创伤小,并发症少,值得临床推广使用。展开更多
文摘Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy;Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.
文摘目的探讨子宫颈环形电切术(LEEP)对宫颈癌前病变的疗效。方法选取200例宫颈上皮内瘤样病变(CIN)患者,均行LEEP治疗,观察并记录患者的手术时间、术中出血量、不同程度CIN患者治愈例数,对比患者术前阴道镜下宫颈活检和LEEP术后病理组织检查结果,记录随访1个月期间并发症情况。结果患者所需手术时间6~22 min,平均手术时间(7.9±1.8)min;术中出血量16~41 m L,平均术中出血量(21.3±8.9)min。术后病理结果证实:CINⅠ72例患者,全部治愈,治愈率100%,CINⅡ87例患者,治愈81例,治愈率93.1%,CINⅢ41例患者,治愈37例,治愈率90.2%。不同程度CIN患者治愈率相比,无统计学差异(P>0.05)。术前阴道镜宫颈活检与LEEP术后病理诊断结果比较,CINⅠ病理符合率94.1%,CINⅡ病理符合率83.5%,CINⅢ病理符合率74.5%,不同程度CIN的术后病理符合率相比,差异有统计学意义(P<0.05)。随访1个月,6例出现宫颈粘连,3例宫颈管狭窄,下腹坠痛伴烧灼感7例,并发症发生率8%。结论 LEEP对宫颈癌前病变具有较好的治疗与诊断效果,诊断效果好于术前阴道镜宫颈活检,术后创伤小,并发症少,值得临床推广使用。
