Keywords
Electrosurgery
Histopathology
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Abstract
Objective: Evaluating the epidemiological profile of patients undergoing electrosurgery of the cervix whose histological results were negative and to investigate the indications for EZT and the factors that favored such results, thus reducing unnecessary procedures and overestimation of cytology and biopsy. Methods: Aretrospective, quantitative, cross-sectional, descriptive and observational study was carried out involving patients who presented negative histology for atypia after undergoing EZT of the cervix from January 2021 to December 2022, in a public hospital in the Federal District. Results: 76 patients who met the inclusion criteria were included in the study. Most of them were between 30 and 49 years old and 50% were multiparous. The most common cytological alteration was ASCH, followed by HSIL. Colposcopy showed that 30,3% had major findings. Approximately 32% of patients underwent incisional biopsy. Conclusion: It is concluded that new diagnostic strategies before EZT must be implemented in the service in an attempt to reduce excessive treatment.
References
AARNIO R, et al. Diagnostic excision of the cervix in women over 40 years with human papilloma virus persistency and normal cytology. Eur J Obstet Gynecol Reprod Biol X., 2019; 3: 100042.
BRASIL. Instituto Nacional de Câncer. Dados e números sobre câncer do colo do útero. Rio de Janeiro: INCA, 2022; 28.
BRASIL. Diretrizes Brasileiras para o Rastreamento do Câncer do Colo de útero. Rio de Janeiro: INCA, 2016; 2.
BONOW MP, et al. When is There no Benefit in Performing a Biopsy in the Suspicion of Intraepithelial Lesions of the Cervix? Rev Bras Ginecol Obstet., 2022; 44(3): 272-279.
BUTORAC D, et al. Twenty-year experience with large loop excision of the transformation zone at sestre milosrdnice University Hospital Centre. Acta Clin Croat., 2019; 58(3): 463-466.
DEODHAR KK, et al. Study of histopathology reports of loop electrosurgical excision procedure of cervical transformation zone and their correlation with preprocedural cervical biopsy and/or cytology: An audit. Indian J Pathol Microbiol., 2022; 65(2): 392-395.
EBISCH RM, et al. Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis. BJOG, 2016; 123(1): 59-66.
GALVÃO, RO. Neoplasia intraepitelial escamosa cervical: abordagem por estimativas de risco. Femina, 2022; 50(7): 428-34.
GEZER S, et al. The concordance between colposcopic biopsy and loop electrosurgical excision procedures in patients with known smear cytology and human papillomavirus results. North Clin Istanb., 2021; 8(6): 588-594.
GUO Y, et al. Absence of high-grade cervical intraepithelial neoplasia in conization specimens from patients with colposcopic biopsy-confirmed high-grade cervical intraepithelial neoplasia: Retrospective study of 1695 cases. Front Oncol., 2022; 12: 980884.
HEFLER L, et al. Necessity of colposcopy and biopsy prior to large loop excision of the transformation zone (LLETZ). Anticancer Res., 2008; 28(1B): 519-21.
JUNG Y, et al. Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix. Obstet Gynecol Sci., 2018; 61(4): 477-488.
KIVIHARJU M, et al. Overtreatment rate after immediate local excision of suspected cervical intraepithelial neoplasia: A prospective cohort study. Gynecol Oncol., 2022; S0090-8258(22): 01836-4.
LI Y, et al. Correlation between multi-type human papillomavirus infections and viral loads and the cervical pathological grade. Int J Gynaecol Obstet., 2021; 152(1): 96-102.
MCGREGOR AE e GECSI K. Effect of Immediate Loop Electrode Excisional Procedure for High-Grade Cervical Cytology in an Urban Academic Clinic Setting. J Low Genit Tract Dis., 2018; 22(4): 311-313.
MEIJER CJLM e SNIJDERS PJF. Human Papillomavirus Triage of Women With Atypical Squamous Cells of Undetermined Significance-Reduction of Overtreatment Needed. JAMA Oncol., 2017; 3(10): 1310-1311.
NOOTHONG S, et al. Pathological discrepancy between colposcopic directed cervical biopsy and Loop Electrosurgical-Excision Procedures (LEEPs) in patients with biopsies proven high grade cervical intraepithelial neoplasia. Taiwan J Obstet Gynecol., 2017; 56(5): 628-631.
POOMTAVORN Y, et al. Predictors of Absent High-grade Cervical Intraepithelial Neoplasia (CIN) in Loop Electrosurgical Excision Procedure Specimens of Patients with Colposcopic Directed Biopsy-Confirmed High-Grade CIN. Asian Pac J Cancer Prev., 2019; 20(3): 849-854.
PITOL, BCV. Análise da expressão das proteínas p16, p53 e L1/HPV nas lesões intraepiteliais cervicais. Dissertação (Mestrado em ciências farmacêuticas) - Escola de Farmácia. Universidade Federal de Ouro Preto, Ouro Preto, 2012; 126.
SILVA GFS, et al. Comparativo Histopatológico entre a Conização a Frio e a Cirurgia de Alta Frequência em um Hospital de Referência. Recife, 2020; 29.
TOKMAK A, et al. Clinical Significance of Atypical Squamous Cells of Undetermined Significance in Detecting Preinvasive Cervical Lesions in Post-Menopausal Turkish Women. Asian Pac J Cancer Prev., 2014; 15(16): 6639-41.
OMS. Guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. Geneva: WHO, 2021; 1.
ZHANG L, et al. Discrepancies between biopsy-based and excision-based grading of cervical intraepithelial neoplasia: the important role of time between excision and biopsy. Int J Gynecol Pathol., 2015; 34(3): 221-7.