Journal Article Ahead of print
PubMed: 42316784 DOI: 10.1111/aogs.70213
Predictive factors for the absence of high-grade intraepithelial lesions in LLETZ specimens following a prior histological diagnosis.
Acta Obstet Gynecol Scand
Authors: Sophia Assirlikian, Julien Mancini, Charles-André Philip, Geoffroy Canlorbe, Henri Azaïs, Eva Fuss-Blanco, Lise Lecointre, Karine Le Bail Carval, Dave Nkounawa, Andriniaina Ravelojaona, Xavier Carcopino
Affiliations
- Obstetrics and Gynaecology Department, Hôpital Nord, APHM, Marseille, France.
- Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
- Department of Biostatistics and Technologies of Information (BIOSTIC), Hôpital de la Timone, Marseille, France.
- Obstetrics and Gynaecology Department, Hôpital Femme Mère Enfant, HCL, Lyon, France.
- Department of Surgery & Gynaecological and Breast Oncology, Hôpital Pitié Salpêtrière, APHP, Paris, France.
- Gynecological and Breast Oncology Surgery Department, Hôpital Européen Georges Pompidou, APHP, Paris, France.
- Obstetrics and Gynaecology Department, Hospital de Hautepierre, Strasbourg, France.
- Gynaecologic Surgery Department, Centre Hospitalier de Calais, Calais, France.
- Gynaecology and Obstetrics Department, Centre Hospitalier d'Avignon, Avignon, France.
- Aix-Marseille University (AMU), UnivAvignon, CNRS, IRD, IMBEUMR7263, Marseille, France.
Abstract
INTRODUCTION
To identify predictive factors of the absence of high-grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high-grade intraepithelial lesion.
MATERIAL AND METHODS
We conducted a multicenter retrospective study in nine hospitals. All patients treated by large loop excision of the transformation zone following histological diagnosis of high-grade intraepithelial lesion between 2015 and 2021 were included. All patients had initial diagnosis of high-grade intraepithelial lesion performed on cervical biopsy and/or endocervical curettage. Clinical, cytological, colposcopic, and high-grade intraepithelial lesion data were extracted from medical files. The primary endpoint was the absence of high-grade intraepithelial lesion on the specimen, defined either by the identification of a low-grade intraepithelial lesion only or by the absence of any intraepithelial lesion.
RESULTS
A total of 2037 patients were included. The absence of high-grade intraepithelial lesion was identified in 191 (9.4%) patients. Three predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen were identified: a small abnormal transformation zone defined by cervical involvement less than or equal to one quadrant (aOR: 2.01; 95%CI: 1.47-2.75; p < 0.001), a colposcopic impression of normal cervix or minor changes (aOR: 1.73; 95%CI: 1.24-2.42; p = 0.001), and normal or low-grade or ASC-US cytology (aOR: 1.37; 95%CI: 1.00-1.87; p = 0.049).
CONCLUSIONS
Predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen of patients with a histological diagnosis of high-grade intraepithelial lesion are a small abnormal transformation zone, a colposcopic impression of normal cervix or minor changes, and normal, low-grade or ASC-US cytology. Practitioners should take these three elements into account when considering large loop excision of the transformation zone treatment in women with a proven diagnosis of high-grade intraepithelial lesion.
MeSH
Absenteeism, Obstetrics, Cell Biology, Gynecology, Diagnosis, Colposcopy, Wounds And Injuries, Cervix Uteri, Cytology