Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia after large loop excision of transformation zone: Do we need a different follow-up strategy?
Summary of "Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia after large loop excision of transformation zone: Do we need a different follow-up strategy?"
Aims:  The aim of this study was to determine the effect of endocervical crypt involvement in specimens with clear margins on recurrence following large loop excision of transformation zone (LLETZ). Material and Methods:  This was an observational cohort study. In the colposcopy unit in a university teaching hospital we prospectively collected data for women who underwent LLETZ treatment for high-grade cervical intraepithelial neoplasia (CIN) between 2003 and 2004. We determined the difference in recurrence rate and need for repeat treatment between groups with and without crypt involvement in the primary histology. We prospectively collected data of follow up until 2010. The recurrence was analyzed using Cox regression. Results:  A total of 309 women had complete excision of the margins following LLETZ treatment for CIN 2 or 3. There was no significant difference in age between groups with (30.2) and without (29.7) crypt involvement (P < 0.25). There was a significant difference in the prevalence of abnormal smear results before and after LLETZ between groups with or without crypt involvement (P = 0.043). The need to perform a repeated treatment was significantly different between groups with and without crypt involvement (P < 0.024). A full model significantly predicted recurrence of cervical pathology (P < 0.009) that necessitated treatment when crypt involvement was present. The odds ratio for repeat treatment with crypt involvement was 2.67 (confidence interval, 1.27-5.64). Conclusions:  Our study showed that positive involvement of endocervical crypt by CIN in a cervical loop excision specimen increases the frequency of subsequent episodes of treatment.
Affiliation
Departments of Gynaecological Oncology Histopathology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Journal Details
This article was published in the following journal.
Name: The journal of obstetrics and gynaecology research
ISSN: 1447-0756
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22765238
- DOI: http://dx.doi.org/10.1111/j.1447-0756.2012.01943.x
Medical and Biotech [MESH] Definitions
Cervical Intraepithelial Neoplasia
A malignancy arising in uterine cervical epithelium and confined thereto, representing a continuum of histological changes ranging from well-differentiated CIN 1 (formerly, mild dysplasia) to severe dysplasia/carcinoma in situ, CIN 3. The lesion arises at the squamocolumnar cell junction at the transformation zone of the endocervical canal, with a variable tendency to develop invasive epidermoid carcinoma, a tendency that is enhanced by concomitant human papillomaviral infection. (Segen, Dictionary of Modern Medicine, 1992)
Prostatic Intraepithelial Neoplasia
A premalignant change arising in the prostatic epithelium, regarded as the most important and most likely precursor of prostatic adenocarcinoma. The neoplasia takes the form of an intra-acinar or ductal proliferation of secretory cells with unequivocal nuclear anaplasia, which corresponds to nuclear grade 2 and 3 invasive prostate cancer.
Carcinoma, Mucoepidermoid
A tumor of both low- and high-grade malignancy. The low-grade grow slowly, appear in any age group, and are readily cured by excision. The high-grade behave aggressively, widely infiltrate the salivary gland and produce lymph node and distant metastases. Mucoepidermoid carcinomas account for about 21% of the malignant tumors of the parotid gland and 10% of the sublingual gland. They are the most common malignant tumor of the parotid. (From DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p575; Holland et al., Cancer Medicine, 3d ed, p1240)
Mucoepidermoid Tumor
A malignant epithelial tumor of glandular tissue, especially the salivary glands, characterized by acini with mucus-producing cells and by the presence of malignant squamous elements. Most mucoepidermoid tumors are low-grade lesions readily cured by adequate excision. They may appear in any age group. They grow slowly. If high-grade, they behave aggressively, widely infiltrating the salivary gland and producing lymph node and distant metastases. (Dorland, 27th ed; from DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p575)
Chlorella
Nonmotile unicellular green algae potentially valuable as a source of high-grade protein and B-complex vitamins.
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