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  • Title: [Clinical significance of loop electrosurgical excisional procedure in diagnosis and treatment of cervical adenocarcinoma in situ and invasive cervical adenocarcinoma].
    Author: Song Y, Wang Q, Sui L, Gao SJ.
    Journal: Zhonghua Fu Chan Ke Za Zhi; 2018 Mar 25; 53(3):178-182. PubMed ID: 29609232.
    Abstract:
    Objective: To evaluate the accuracy of colposcopic biopsy on diagnosis of cervical adenocarcinoma in situ (AIS) and the clinical significance of loop electrosurgical excisional procedure (LEEP) on diagnosis and treatment of AIS and invasive adenocarcinoma. Methods: All medical records of 193 patients diagnosed as AIS by colposcopic biopsy and (or) AIS or invasive adenocarcinoma diagnosed by LEEP conization from Jan. 2015 to Dec. 2016 in Obstetrics and Gynecology Hospital of Fudan University were retrospectively reviewed. The final diagnosis was based on colposcopic biopsy or LEEP or the highest grade of pathological diagnosis after hysterectomy. Results: In the 193 patients, 155 cases were finally diagnosed as AIS and 38 cases as invasive adenocarcinoma by histopathologic examination. Among the 155 AIS patients, 21.9% (34/155) had positive cone margins, in which 26 patients had hysterectomy, 30.8% (8/26) had residual disease in hysterectomy specimens; 78.1% (121/155) had negative cone margins, 68 patients with negative margins had hysterectomy and 5.9% (4/68) had residual disease, which was significantly lower than that with positive margins (χ(2)=10.46, P=0.001) . One hundred and twenty from one hundred ninty-three (62.3%, 120/193) with AIS were detected by colposcopy. Pathological diagnosis of 50.8% (98/193) cases were upgraded after LEEP conization. Conclusions: Colposcopy is indispensable for the diagnosis of AIS, but accurate diagnosis should be made by LEEP. LEEP is capable of detecting AIS or cervical adenocarcinoma that was misdiagnosed by colposcopy, which is a pivotal method for accurate diagnosis. The margin status of LEEP is important for patients in choosing further hysterectomy, but the presence of cervical adenocarcinoma should always be aware of. 目的： 探讨子宫颈环形电切除（LEEP）术在子宫颈原位腺癌（AIS）及子宫颈腺癌诊断和治疗中应用的临床意义。 方法： 收集2015年1月至2016年12月在复旦大学附属妇产科医院宫颈疾病诊疗中心行阴道镜活检后病理诊断为AIS和（或）LEEP术后病理诊断为AIS及子宫颈腺癌的患者193例，对其临床病理资料进行回顾性分析。以阴道镜活检、LEEP或子宫切除术后病理诊断中病变级别最高者为最终诊断。 结果： 193例患者中，最终诊断为AIS 155例、子宫颈腺癌38例。155例AIS患者中，LEEP术切缘阳性率为21.9%（34/155），其中26例进一步行子宫全切除术，其病灶残留率为30.8%（8/26）；LEEP术切缘阴性率为78.1%（121/155），其中68例进一步行子宫全切除术，其病灶残留率5.9%（4/68），显著低于LEEP术切缘阳性者（χ(2)=10.46，P=0.001）。38例子宫颈腺癌患者中，35例行子宫广泛性或次广泛性切除术，其病灶残留率为42.9%（15/35）。阴道镜活检的AIS检出率为62.2%（120/193）；LEEP术后病理诊断较LEEP术前诊断病变升级的患者98例（50.8%，98/193）。 结论： 阴道镜对AIS的诊断不可或缺，但需LEEP术确诊。LEEP术可检出阴道镜没有检出的AIS或子宫颈腺癌，是进一步明确诊断的重要手段。LEEP术的切缘状态对患者选择是否行保留子宫的治疗有重要参考意义，但仍需警惕子宫颈腺癌的存在。.
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