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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(09): 941-948
DOI: 10.1055/a-1202-2157
GebFra Science
Original Article

Expansile Endocervical Crypt Involvement by CIN2 – 3 as a Risk Factor for High Grade Cytology Recurrence After Cold Coagulation Cervical Treatment

Ausgedehnte CIN II – III in den endozervikalen Krypten als Risikofaktor für ein hochgradiges zytologisches Rezidiv nach kalter Koagulation
Dimitrios Papoutsis
1   Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom
2   Department of Health Sciences, University of Western Macedonia, Koila, Kozani, Greece
,
Martyn Underwood
1   Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom
,
Joanna Williams
3   Department of Histopathology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom
,
William Parry-Smith
1   Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom
,
Jane Panikkar
1   Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom
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Abstract

Introduction To determine whether expansile endocervical crypt involvement (ECI) on pretreatment cervical punch biopsies is a risk factor for high grade cytology recurrence in women following cold coagulation for cervical intraepithelial neoplasia (CIN).

Materials and Methods This was a secondary analysis on the results of an observational study of women who had a single cold coagulation cervical treatment between 2001 – 2011 and who were followed up for cytology recurrence. Women with a previous cervical treatment were excluded.

Results 559 women were identified with a mean age of 28.7 ± 6.2 years. Expansile and non-expansile ECI were identified in 5.4 and 4.3% of women, respectively. The proportion of women with high grade cytology recurrence was 10% for those with expansile ECI and 2.3% for those without. Multivariate analysis showed that women with expansile ECI when compared to those without, had a four-fold greater risk for high grade cytology recurrence (HR = 4.22; 95% CI: 1.10 – 16.29, p = 0.036). There was no significant association found between non-expansile ECI and overall or high grade cytology recurrence. The increased biopsy depth and the CIN3 grade of pretreatment cervical punch biopsies were significantly associated with greater odds for the detection of expansile ECI. We calculated that the optimal-cut off of pretreatment cervical punch biopsy depth for the detection of expansile ECI was 4 mm (sensitivity: 73.3%; specificity: 55.1%).

Conclusions Expansile ECI is a risk factor that increases the likelihood of high grade cytology recurrence following cold coagulation. Deeper pretreatment cervical punch biopsies need to be taken so as not to miss expansile ECI prior to ablative treatment.

Zusammenfassung

Einleitung Ziel dieser Studie war es, herauszufinden, ob ein bei der Stanzbiopsie ermittelter ausgedehnter Befall der endozervikalen Krypten (endocervical crypt involvement, ECI) einen Risikofaktor für ein hochgradiges zytologisches Rezidiv bei Frauen darstellt, die mit kalter Koagulation zur Behandlung zervikaler intraepithelialen Neoplasien (CIN) therapiert wurden.

Material und Methoden Es handelt sich hierbei um eine sekundäre Analyse einer Observationsstudie von Frauen, die sich zwischen 2001 – 2011 einer Zervixbehandlung mit kalter Koagulation unterzogen und anschließend regelmäßig zur zytologischen Nachkontrolle einbestellt wurden. Frauen, die sich zuvor einer Zervixbehandlung unterzogen hatten, wurden von der Studie ausgeschlossen.

Ergebnisse Insgesamt wurden 559 Frauen identifiziert, mit einem mittleren Alter von 28,7 ± 6,2 Jahren. Bei 5,4 bzw. 4,3% dieser Frauen wurde ein ausgedehntes resp. nicht ausgedehntes ECI festgestellt. Der Anteil Frauen mit hochgradigen zytologischen Rezidive betrug 10% bei den Frauen mit ausgedehntem Befall und 2,3% bei denen ohne ausgedehnten Befall. Bei der multivariaten Analyse stellte sich heraus, dass Frauen mit einem ausgedehnten zervikalen Befall ein 4-fach höheres Risiko für ein hochgradiges zytologisches Rezidiv hatten als Frauen ohne ausgedehnten Befall (HR = 4,22; 95%-KI 1,10 – 16,29; p = 0,036). Es gab keinen signifikanten Zusammenhang zwischen nicht ausgedehntem Befall und einem allgemeinen bzw. hochgradigen zytologischen Rezidiv. Biopsietiefe und ein CIN-III-Befund bei der zervikalen Stanzbiopsie vor der Behandlung waren signifikant mit einer höheren Wahrscheinlichkeit eines ausgedehnten ECI assoziiert. Nach unseren Berechnungen betrug die optimale Tiefe für zervikale Stanzbiopsien zur Entdeckung eines ausgedehnten ECI 4 mm (Sensitivität: 73,3%; Spezifizität: 55,1%).

Schlussfolgerungen Ein ausgedehntes ECI stellt einen Risikofaktor dar, der die Wahrscheinlichkeit eines hochgradigen zytologischen Rezidivs nach kalter Koagulation erhöht. Es empfiehlt sich, tiefere zervikale Biopsien zu nehmen, um sicherzustellen, dass ausgedehnte ECI vor der ablativen Behandlung entdeckt werden.

Key words

cold coagulation - endocervical crypt involvement - cytology recurrence - CIN

Schlüsselwörter

kalte Koagulation - Befall der endozervikalen Krypten - zytologisches Rezidiv - CIN


Publication History

Received: 28 December 2019

Accepted after revision: 17 June 2020

Article published online:
02 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Stuttgart · New York

 

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