Loop electrosurgical excision procedure (LEEP) plus top hat for HIV-infected women with endocervical intraepithelial neoplasia in Kenya.

Autor: Chung MH; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.; Department of Medicine, Emory University, Atlanta, GA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA., De Vuyst H; Prevention and Implementation Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France., Greene SA; Department of Epidemiology, University of Washington, Seattle, WA, USA., Topazian HM; Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA., Sayed S; Department of Pathology, Aga Khan University, Nairobi, Kenya., Moloo Z; Department of Pathology, Aga Khan University, Nairobi, Kenya., Cagle A; Department of Global Health, University of Washington, Seattle, WA, USA., Nyongesa-Malava E; Department of Surgery, Coptic Hospital, Nairobi, Kenya., Luchters S; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.; Department of Population Health, Aga Khan University, Nairobi, Kenya., Temmerman M; Department of Obstetrics & Gynecology, Aga Khan University, Nairobi, Kenya., Sakr SR; Department of Surgery, Coptic Hospital, Nairobi, Kenya., Mugo NR; Department of Global Health, University of Washington, Seattle, WA, USA.; Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya., McGrath CJ; Department of Global Health, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2021 Jan; Vol. 152 (1), pp. 118-124. Date of Electronic Publication: 2020 Dec 11.
DOI: 10.1002/ijgo.13466
Abstrakt: Objective: To determine the utility of detecting endocervical cervical intraepithelial neoplasia (CIN) 2+ with endocervical curettage (ECC) and treating with loop electrosurgical excision procedure (LEEP) plus top hat (+TH) among women with HIV.
Methods: Cytology was followed by coloscopy-directed biopsy if participants had HSIL or ASC-H and biopsy plus ECC if there were glandular cells present. CIN2/3 on ECC and/or inadequate colposcopy (ENL) was treated with LEEP+TH, while CIN2/3 on ectocervix (ECL) received LEEP alone. Recurrent CIN2+ were compared over a 2-year follow-up.
Results: Of 5330 participants, 160 underwent ECC, 98 were CIN2/3 on ECC, and 77 received LEEP+TH. ECC detected 15 (9%) more women with CIN2/3 than biopsy alone. Women were more likely to have ENL if they were older (≥45 vs <35 years) (adjusted relative risk [aRR] 2.14; P = 0.009) and on antiretroviral treatment longer (≥2 vs <2 years) (aRR 3.97; P < 0.001). Over the 2-year follow-up, 35 (29%) ENL had recurrent CIN2+ after TH compared to 19 (24%) ECL after LEEP (hazard ratio 1.32; 95% confidence interval 0.75-2.31; P = 0.338).
Conclusion: Among HIV-infected women, adding ECC did not increase detection of pre-cancerous disease significantly and treatment with LEEP+TH for ENL was comparable to treatment with LEEP for ECL.
(© 2020 International Federation of Gynecology and Obstetrics.)
Databáze: MEDLINE
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