Small lesion size measured by colposcopy may predict absence of cervical intraepithelial neoplasia in a large loop excision of the transformation zone specimen

Autor: M. Cardona, M Juiz, Aureli Torné, Lorena Marimon, Jaume Ordi, Meritxell Munmany, R Astudillo, M del Pino, Roser Nonell
Rok vydání: 2016
Předmět:
Zdroj: BJOG : an international journal of obstetrics and gynaecology. 124(3)
ISSN: 1471-0528
Popis: Objective To evaluate whether colposcopic measurement of the lesion size at diagnosis and/or human papillomavirus (HPV) genotyping can predict the absence of dysplasia in a large loop excision of the transformation zone (LLETZ) specimen in women treated for squamous intraepithelial lesions/cervical intraepithelial neoplasia (SIL/CIN). Design Prospective observational study. Setting Tertiary university hospital. Population A cohort of 116 women who underwent LLETZ because of biopsy-proven low-grade SIL/CIN that had persisted for 2 years, or because of a high-grade SIL/CIN diagnosed in the referral visit and squamocolumnar junction completely visible (types 1 or 2, according to the International Federation of Cervical Pathology and Colposcopy, IFCPC). Methods After LLETZ the women were classified by histology into the study group (absence of SIL/CIN in the surgical specimen, 28/116, 24.1%) and the control group (SIL/CIN in the LLETZ specimen, 88/116, 75.9%). Main outcome measures The size of the lesion determined in the diagnostic colposcopy and the HPV genotype were evaluated in all women. Results The lesion size was significantly smaller in the study group (25.7 ± 37.8 versus 84.5 ± 81.7 mm2; P < 0.001). A lesion size of ≤12 mm2 and HPV types other than 16 or 18 were associated with an absence of SIL/CIN in the LLETZ specimen (P < 0.001 and P = 0.016, respectively). On multivariate analysis only a lesion size of ≤12 mm2 predicted the absence of SIL/CIN (odds ratio, OR 10.6; 95% confidence interval, 95% CI 3.6–30.6; P < 0.001). A lesion size of ≤12 mm2 had a specificity of 90.9% (95% CI 83.0–95.3%) and a negative predictive value of 86.0% (95% CI 77.5–91.6%) to predict the absence of SIL/CIN in the surgical specimen. Conclusions Small lesion size in diagnostic colposcopy could predict the absence of SIL/CIN in the LLETZ specimen. Colposcopy measurement of lesion size prior to LLETZ may avoid unnecessary treatment. Tweetable abstract Small lesion size in colposcopic evaluation might predict the absence of SIL/CIN in an LLETZ specimen.
Databáze: OpenAIRE
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