The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease.

Cuello, Mauricio A; Espinosa, María E; Orlandini, Elisa J; Hwang, Du Y

Cuello, Mauricio A; Espinosa, María E; Orlandini, Elisa J; Hwang, Du Y.

Afiliação

Cuello MA; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Espinosa ME; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Orlandini EJ; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Hwang DY; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Int J Gynaecol Obstet ; 141(3): 337-343, 2018 Jun.

Article em En | MEDLINE | ID: mdl-29509961

RESUMO

OBJECTIVE: To evaluate the usefulness of endocervical curettage (ECC) during loop electrosurgical excision procedures (LEEPs) in predicting the risk of persistence/recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) and informing clinical decision-making after LEEP. METHODS: The present retrospective study included women undergoing LEEP for CIN2+ at a teaching hospital in Chile between January 1, 2007, and December 31, 2014. Demographic, pathologic, and follow-up data were collected. Associations between predictors and treatment failure (persistent/recurrent disease) were examined; a Cox model was used to assess the effects of different variables on the failure rate. RESULTS: The analysis included 330 women with a mean follow-up of 29.4 months; 188 women underwent ECC at the time of LEEP. On multivariate analysis, a positive ECC was the only variable significantly associated with persistence/recurrence (P=0.001). In the Cox model, positive ECC (P=0.001) and positive margins (P=0.009) were independently associated with higher failure rates. When faced with positive ECC findings, clinicians tended to perform additional treatment instead of advising follow-up. CONCLUSION: Positive findings from ECC performed during LEEP were a better predictor of persistent/recurrent disease than margin status, after adjusting the individual variable effect in the Cox modelling. The performance of ECC is recommended during any LEEP performed for CIN2+; in particular, it should never be omitted if endocervical disease is suspected.

Assuntos

Curetagem/métodos; Eletrocirurgia/métodos; Displasia do Colo do Útero/cirurgia; Neoplasias do Colo do Útero/cirurgia; Adulto; Feminino; Humanos; Recidiva Local de Neoplasia/cirurgia; Estudos Retrospectivos; Fatores de Risco; Traquelectomia/métodos; Neoplasias do Colo do Útero/patologia; Displasia do Colo do Útero/patologia

Palavras-chave

Cervical intraepithelial neoplasia (CIN); Cone biopsy; Endocervical curettage; Loop electrosurgical excisional procedure (LEEP); Recurrence

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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Displasia do Colo do Útero / Neoplasias do Colo do Útero / Curetagem / Eletrocirurgia Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Adult / Female / Humans Idioma: En Revista: Int J Gynaecol Obstet Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Chile País de publicação: Estados Unidos

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