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- 宫颈活检，协助诊断（免疫组化公布）
Obstet Gynecol. 2009 Oct;114(4):727-35.
Pregnancy outcome after treatment for cervical intraepithelial neoplasia.
Shanbhag S, Clark H, Timmaraju V, Bhattacharya S, Cruickshank M.
University Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, United Kingdom. s.shanbhag@nhs.net
Abstract
OBJECTIVE: To estimate the rate of spontaneous preterm delivery and preterm premature rupture of membranes (PROM) in women with cervical intraepithelial neoplasia (CIN) 3.
METHODS: This retrospective cohort analysis was performed on routinely collected Scottish national data. The exposed cohort comprised all women with CIN3; the unexposed cohort were women with no record of CIN. Further comparisons were made within the exposed cohort based on the type of treatment they had for CIN3. The primary outcomes were spontaneous preterm delivery and preterm PROM in their first pregnancies.
RESULTS: Women with CIN3 were significantly more likely to have spontaneous preterm deliveries (11% compared with 6%, odds ratio [OR] 1.52, 95% confidence interval [CI] 1.29-1.80, P<.001) and preterm PROM (8% compared with 6%, OR 1.27, 95% CI 1.09-1.48, P=.001) as compared with the unexposed population. These differences were not seen between the different treatment groups within the exposed cohort.
CONCLUSION: Women with CIN3 have higher rates of spontaneous preterm delivery and preterm PROM than do those in the general population. Loop electrosurgical excision procedure did not alter these pregnancy complication rates. Women should be counseled adequately before treatment but should be reassured regarding the treatment of CIN on the risk of preterm delivery.
LEVEL OF EVIDENCE: II.
Pregnancy outcome after treatment of cervical intraepithelial neoplasia by the loop electrosurgical excision procedure and cold knife conization.
Michelin MA, Merino LM, Franco CA, Murta EF.
Research Institute of Oncology (IPON), Discipline of Gynecology and Obstetrics, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil.
Abstract
PURPOSE OF INVESTIGATION: The aim of this study was to evaluate the effect of LEEP and cold-knife conization on the outcome of subsequent pregnancy in a tertiary public hospital.
METHODS: One hundred and ninety-nine patients met the inclusion criteria (age between 18 and 45 years old). Cold-knife conization, LEEP, and both (conization and LEEP) were performed in 102 (51.3%), 95 (47.7%) and two (1%) women, respectively. Average ages were respectively, 33 +/- 7.3; 25 +/- 6.73 and 30 +/- 2.8.
RESULTS: Pregnancies occurred 2.6 and 4.8 years after LEEP and conization, respectively. Miscarriages and preterm pregnancies were more frequent in conization cases versus LEEP, 26% and 5.2%, 23% and 5.5%, respectively.
CONCLUSION: If patients express a desire for pregnancy, LEEP should be the procedure of choice.
Acta Obstet Gynecol Scand. 2007;86(4):423-8.
Pregnancy outcome after cervical cone excision: a case-control study.
Sjøborg KD, Vistad I, Myhr SS, Svenningsen R, Herzog C, Kloster-Jensen A, Nygård G, Hole S, Tanbo T.
Department of Obstetrics and Gynecology, Oestfold Hospital Trust, Fredrikstad, Norway. xatsjo@so-hf.no
Abstract
BACKGROUND: To investigate the effect of cervical laser conisation (CLC) or loop electrosurgical excision procedure (LEEP) on the outcome of subsequent pregnancies. Methods. Multi-centre, retrospective, case-control study, which included a cohort of 742 women, who, after treatment with LEEP or CLC, gave birth or suffered second trimester miscarriage. Control women (n=742) were extracted from the respective hospital birth registries and matched by age and parity. Outcome measures were perinatal mortality, length of gestation, birth weight and preterm premature rupture of membranes (pPROM).
RESULTS: There was no significant difference in perinatal mortality among women treated with LCL or LEEP compared to controls, 6/742 versus 2/742: odds ratio (OR)=3.1 (95% CI: 0.6-15.2). Excluding second trimester miscarriages, ORs for giving birth before week 37, 32 and 28 after conisation compared to the controls were 3.4 (95% CI: 2.3-5.1), 4.6 (95% CI: 1.7-12.5), and 12.4 (95% CI: 1.6-96.1), respectively, after adjusting for smoking habits during pregnancy, marital status and educational level. Adjusted ORs of birth weight <2,500, <1,500 and <1,000 g after conisation compared to controls were 3.9 (95% CI: 2.4-6.3), 4.4 (95% CI: 1.5-13.6), and 10.4 (95% CI: 1.3-82.2), respectively. The adjusted OR for pPROM was 10.5 (95% CI: 3.7-29.5).
CONCLUSION: Treatment by CLC and LEEP increases the risk of preterm delivery, low birth weight and pPROM in subsequent pregnancies.
THis is summary for 27 studies
Lancet. 2006 Feb 11;367(9509):489-98.
Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis.
Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E.
Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals, Preston, UK. mkyrgiou@yahoo.com
Abstract
BACKGROUND: Conservative methods to treat cervical intraepithelial neoplasia and microinvasive cervical cancer are commonly used in young women because of the advent of effective screening programmes. In a meta-analysis, we investigated the effect of these procedures on subsequent fertility and pregnancy outcomes.
METHODS: We searched for studies in MEDLINE and EMBASE and classified them by the conservative method used and the outcome measure studied regarding both fertility and pregnancy. Pooled relative risks and 95% CIs were calculated with a random-effects model and interstudy heterogeneity was assessed with Cochrane's Q test.
FINDINGS: We identified 27 studies. Cold knife conisation was significantly associated with preterm delivery (<37 weeks; relative risk 2.59, 95% CI 1.80-3.72, 100/704 [14%] vs 1494/27 674 [5%]), low birthweight (<2500 g; 2.53, 1.19-5.36, 32/261 [12%] vs 905/13 229 [7%]), and caesarean section (3.17, 1.07-9.40, 31/350 [9%] vs 22/670 [3%]). Large loop excision of the transformation zone (LLETZ) was also significantly associated with preterm delivery (1.70, 1.24-2.35, 156/1402 [11%] vs 120/1739 [7%]), low birthweight (1.82, 1.09-3.06, 77/996 [8%] vs 49/1192 [4%]), and premature rupture of the membranes (2.69, 1.62-4.46, 48/905 [5%] vs 22/1038 [2%]). Similar but marginally non-significant adverse effects were recorded for laser conisation (preterm delivery 1.71, 0.93-3.14). We did not detect significantly increased risks for obstetric outcomes after laser ablation. Although severe outcomes such as admission to a neonatal intensive care unit or perinatal mortality showed adverse trends, these changes were not significant.
INTERPRETATION: All the excisional procedures to treat cervical intraepithelial neoplasia present similar pregnancy-related morbidity without apparent neonatal morbidity. Caution in the treatment of young women with mild cervical abnormalities should be recommended. Clinicians now have the evidence base to counsel women appropriately.
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本帖最后由 于 2010-10-31 20:50:00 编辑
Generally speaking, LEEP一般不影响生育功能. May have some 影响for abortion, preterm when the procedure was perfomed on pregnant women. It will also depend on the experience of gynecologists. Colposcopy for pregnant women should be performed by experienced gynecologists
Cone/LEEP这个病人的一生就毁了！有点过了。
Anyway， very appreciate Dr. Xu's 严谨的工作态度，值得我们大家学习
This is my study result
Histological Follow-up Findings in Adolescents with HSIL Cytology Results
Arch Path Lab Med in print.
Magee Womens Hospital, UPMC,
Abstract:
Introduction:
The incidence of cervical intraepithelial lesions is increased in adolescents and reflects the high prevalence of hrHPV infection in this special population. Recent follow-up guidelines emphasize conservative follow-up options. Furthermore, data from cohort studies suggest that regression of both low grade and high grade CIN are quite frequent in very young women. In this study we analyzed histological follow-up data for adolescent women who had HSIL cytology reports. We also assessed the effect of presence or absence of an adequate TZ/ECS in liquid-based Pap tests on the follow-up biopsy diagnoses.
Materials and methods:
The computerized records of a large academic women’s hospital were searched for cases reported as HSIL on TPPT in women age 20 or younger over a 6 year span between January 2002 and December, 2007. Histologic and Pap follow-up results, variations among age groups of adolescent women, and impact of presence or absence of TZ/ECS in Pap test were analyzed. Chi-Square test analysis was performed using SAS 9.1 System.
Results:
During the study period a total of 474 women age 20 or younger had HSIL Pap test results. 335 adolescent women with at least one cervical biopsy with or without endocervical curettage were included in the analysis. The average age was 18.6 years (13-20 years). The average follow-up period was 24 months (0 to 75 months) with a median of 22 months. The overall histologic CIN2/3 and detection rate was 44.2% and 47.8% for CIN1. The average period between the HSIL Pap test and an initial diagnosis of CIN2/3 was 5 months (0-62 months) with a median 2 months. The rates for histologic documentation of CIN in women age 19-20 compared to younger women were not statistically different. Detailed histologic findings are shown in Table 1. No invasive carcinomas or adenocarcinoma in situ cases were identified in this series of adolescents. The percentage of CIN 2/3 diagnosed on histologic follow up was not statistically significantly different when comparing women with and without a TZ/ECS in their preceding HSIL Pap tests (44.5% vs. 38.9%, p=0.642).
Conclusion:
Less than half of adolescent patients with HSIL cytology results had documented histologic CIN2/3 over an average follow-up period of 24 months, and no cases of invasive carcinoma were identified. CIN1 histologic follow-up findings were as common as CIN2/3 findings, likely reflecting both the increased likelihood of HSIL regression in younger women as well as the challenges of precise cytologic and histologic classification. High rates of hrHPV infection, only moderate rates of histologic CIN2/3 following HSIL cytology, and absence of invasive carcinoma all mark the adolescent group as a unique subset of patients deserving further study. Identification of additional biomarkers for HSIL progression would be useful.
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Histologic Follow-up Finding in Adolescent Women with HSIL Cytology | ||||
|
Age (y) |
F/U No |
Negative (%) |
CIN 1 (%) |
CIN 2/3 (%) |
|
19-20 |
199 |
13 (6.5) |
94 (47.2) |
92 (46.2) |
|
<19 |
136 |
14 (10.3) |
66 (48.5) |
56 (41.2) |
|
Total |
335 |
27 (8.1) |
160 (47.8) |
148 (44.2) |
I feel difficult to give my impression for this case.
Stain results for P16 and Ki67 is consistent with dx of high grade dysplasia, but the cytomorphologic features on H&E are not like classic high grade dysplasia. I favor a dx of CIN2 based on IHC and H&E. However I need to review the true glass for diagnosis.
If luo zhu is not sure, can send out for consultation.
Other suggestions:
1. Dx of CIN1-2 is a bad call. Pathologists should avoid to use the diagnostic term. If patients have both cin1 and cin2, it is fine that you call:
-CIN2.
-CIN1. (of cause it is fine you do not report cin1 if you report cin2 or cin3 already.
Or focal cin2 in the background of CIN1 if cin2 is focal.
If is ok you report CIN2-3 together.
2. For CIN lesion, HPV testing is not used for diagnosis
这里有一篇关于P16与宫颈病变的文献。
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Pathology. 2008 Jun;40(4):335-44. Diagnostic utility of p16INK4a: a reappraisal of its use in cervical biopsies.Mulvany NJ, Allen DG, Wilson SM. Department of Anatomical Pathology, Austin Hospital, Heidelberg, Vic 3084, Australia. nicholas.mulvany@austin.org.au Abstractp16(INK4a), an indirect marker of cell cycle dysregulation, is commonly expressed in cervical dysplasias and carcinomas associated with high risk human papillomavirus (HR-HPV) infections. Although p16(INK4a) immunohistology is routinely used as a cost effective surrogate marker, many of the published articles are confusing and contradictory. The discrepancies can be ascribed to a multitude of factors operating at the molecular, technical and interpretative levels. In the first place, our simplistic model of viral mediated oncogenesis is speculative and fails to account for all the known biomolecular changes. Unresolved technical issues include the variables of tissue fixation, antibody dilution, antibody isotype and clone, and the sensitivity of the particular detection method. Within any controlled staining method, strong diffuse or 'block' immunoreactivity in squamous cells may be found in moderate/severe dysplasia (CIN 2/3) and invasive squamous carcinoma. In contrast, focal or multifocal reactivity in squamous cells may be artefactual, related to low risk or HR-HPV. p16(INK4a) is less reliable when dealing with glandular lesions since considerable overlap exists between reactive and dysplastic lesions. In addition not all glandular dysplasias/carcinomas are HR-HPV related, nor are all p16(INK4a) immunoreactive lesions associated with HR-HPV. We conclude that p16(INK4a) immunoperoxidase shows greater specificity than sensitivity for squamous lesions; in comparison, glandular dysplasias/carcinomas show reduced specificity and sensitivity. Like all cell cycle regulatory proteins, the future diagnostic role of p16(INK4a) is limited. The ideal diagnostic molecular test for cervical dysplasias will detect a HR-HPV related product after, but not before, cell transformation and will reliably predict those cases yet to experience disease progression. |
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