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Archives of Gynecology and Obstetrics

Erschienen in:

01.06.2023 | General Gynecology

How endocervicoscopy can impact obstetric outcomes in women undergoing LEEP for CIN2 + : a retrospective cohort analysis

verfasst von: Luigi Della Corte, Giada Lavitola, Giuseppe Bifulco

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 2/2023

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Abstract

Purpose

To assess the impact of preoperative endocervicoscopy on obstetric outcomes and complications in women undergoing LEEP for CIN2 + .

Methods

This was a retrospective cohort study carried out between October 2012 and April 2018. All women had undergone cervical length measurement at T0 (before LEEP), T1 (6 months after LEEP), and T2 (at 20 weeks of pregnancy) through transvaginal ultrasound examination after LEEP for CIN2 + . A total of 528 patients fulfilled our inclusion criteria and contributed to the final analysis: 288 had undergone endocervicoscopy before the excisional procedure (Group A), while the remaining 240 (Group B) did not.

Results

Patients who did not undergo endocervicoscopy showed a greater amount of tissue excised at LEEP compared to those of Group A (6.7% vs 31.9% in Group A and B, p < 0.01, respectively). A statistically relevant difference was detected in the lesion margins involvement: negative in 93.8% in Group A compared to 65.6% in Group B. The cervicometry before the treatment resulted in similar between the two groups, while a statistically significant difference was noted after 6 months (37.5 ± 2.9 mm in Group A vs 35.1 ± 3.8 mm in Group B, p < 0.01) and at 20th week pregnancy (36.9 ± 5.3 mm in Group A vs 33.5 ± 5.6 mm in Group B, p < 0.01). The number of pregnancies after LEEP as well as the difference in the elapsed time (in months) did not result in a statistical significance between the two groups. The threatened preterm labor (TPL) and the threatened miscarriage showed a statistically significant difference in incidence between the two groups (4,2% and 4.2% in Group A vs 15.3% and 25% in Group B, p < 0.01, respectively).

Conclusion

Endocervicoscopy reduces the size of the LEEP sample and in particular its depth, saving healthy cervical tissue, and guarantees the total eradication of the lesion as the resection margins are negative in almost all cases, allowing for a reduction of the rate of TPL and threatened miscarriage in women with CIN2 + , especially with Type 2 or 3 cervical squamocolumnar junction (SCJ).

Gaffney DK, Hashibe M, Kepka D, Maurer KA, Werner TL (2018) Too many women are dying from cervix cancer: problems and solutions. Gynecol Oncol 151(3):547–554. https://doi.org/10.1016/j.ygyno.2018.10.004. (Epub 2018 Oct 6)CrossRefPubMedPubMedCentral

I Numeri Del Cancro In Italia 2020. https://www.aiom.it/wp-content/uploads/2020/10/2020_Numeri_Cancro-operatori_web.pdf

Muñoz N, Castellsagué X, de González AB, Gissmann L (2006) HPV in the etiology of human cancer. Vaccine. https://doi.org/10.1016/j.vaccine.2006.05.115CrossRefPubMed

Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189(1):12–19. https://doi.org/10.1002/(SICI)1096-9896(199909)189:1%3c12::AID-PATH431%3e3.0.CO;2-FCrossRefPubMed

International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S et al (2007) Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 370(9599):1609–1621. https://doi.org/10.1016/S0140-6736(07)61684-5CrossRef

GISCI. Gruppo Italiano Screening del Cervical Carcinoma. Colposcopy and Programme management—Guidelines fopr NHS Cervical Screening Programme NHSCSP Publication.20 2004. (2004). https://www.gisci.it/documenti/altri_documenti/guidelines_nhs.pdf

Papillomavirus, aggiornate le schedule vaccinali. https://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=null&id=1572.

Carozzi FM, Del Mistro A. Raccomandazioni sul test HR-HPV come test di screening primario 2^ Edizione Versione elaborata dal Gruppo di lavoro GISCi 1° livello ‘HPV test: formazione e valutazione degli indicatori di qualità’ Referenti.

Della Corte L, Mercorio A, Giampaolino P, Vitale SG, Vizzielli G, Bifulco G, Lavitola G (2022) The role of endocervicoscopy in women with cervical intraepithelial neoplasia: a systematic review of the literature. Updates Surg 74(4):1239–1245. https://doi.org/10.1007/s13304-021-01193-2CrossRefPubMed

10.

De Rosa N, Lavitola G, Della Corte L, Bifulco G (2020) Diagnostic accuracy of endocervicoscopy in identifying and grading cervical intraepithelial Neoplasia Lesion. Gynecol Obstet Invest 85(2):196–205. https://doi.org/10.1159/000506801CrossRefPubMed

11.

Bifulco G, Piccoli R, Lavitola G, Di Spiezio SA, Spinelli M, Cavallaro A et al (2010) Endocervicoscopy: a new technique for the diagnostic work-up of cervical intraepithelial neoplasia allowing a tailored excisional therapy in young fertile women. Fertil Steril 94(7):2726–2731. https://doi.org/10.1016/j.fertnstert.2010.03.079CrossRefPubMed

12.

Liverani CA, Di Giuseppe J, Clemente N, Delli Carpini G, Monti E, Fanetti F et al (2016) Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2–3) is a predictor of pregnancy outcome. Eur J Cancer Prev 25(5):416–422. https://doi.org/10.1097/CEJ.0000000000000196CrossRefPubMed

13.

Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M et al (2012) 2011 colposcopic terminology of the international federation for cervical pathology and colposcopy. Obstet Gynecol 120(1):166–172. https://doi.org/10.1097/AOG.0b013e318254f90cCrossRefPubMed

14.

NHS Cervical Screening Programme Colposcopy and Programme Management Public Health England leads the NHS Screening Programmes About Public Health England Screening. (2016)

15.

State of the Art Hysteroscopic Approaches to Pathologies of the Genital Tract—Attilio Di Spiezio Sardo | Ginecologia - Isteroscopia—Gravidanza. https://www.attiliodispiezio.com/news/state-of-the-art-hysteroscopic-approaches-to-pathologies-of-the-genital-tract/

16.

Duggan BD, Felix JC, Muderspach LI, Gebhardt JA, Groshen S, Morrow CP et al (1999) Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study. Am J Obstet Gynecol 180(2 Pt 1):276–282. https://doi.org/10.1016/s0002-9378(99)70200-0CrossRefPubMed

17.

Kleinberg MJ, Straughn JM Jr, Stringer JS, Partridge EE (2003) A cost-effectiveness analysis of management strategies for cervical intraepithelial neoplasia grades 2 and 3. Am J Obstet Gynecol 188(5):1186–1188. https://doi.org/10.1067/mob.2003.280CrossRefPubMed

18.

Mathevet P, Dargent D, Roy M, Beau G (1994) A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP. Gynecol Oncol 54:175–179CrossRefPubMed

19.

Quaas J, Reich O, Frey Tirri B, Küppers V (2013) Explanation and use of the colposcopy terminology of the IFCPC (international federation for cervical pathology and colposcopy) Rio 2011. Geburtshilfe Frauenheilkd 73(9):904–907. https://doi.org/10.1055/s-0033-1350824CrossRefPubMedPubMedCentral

20.

Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E (2006) Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 367(9509):489–498. https://doi.org/10.1016/S0140-6736(06)68181-6CrossRefPubMed

21.

Crane JM (2003) Pregnancy outcome after loop electrosurgical excision procedure: a systematic review. Obstet Gynecol 102(5 Pt 1):1058–1062. https://doi.org/10.1016/s0029-7844(03)00741-5CrossRefPubMed

22.

Ciavattini A, Delli Carpini G, Moriconi L, Clemente N, Montik N, De Vincenzo R et al (2018) Effect of age and cone dimensions on cervical regeneration: an Italian multicentric prospective observational study. BMJ Open 8(3):e020675. https://doi.org/10.1136/bmjopen-2017-020675CrossRefPubMedPubMedCentral

23.

Papoutsis D, Rodolakis A, Mesogitis S, Sotiropoulou M, Antsaklis A (2012) Regeneration of uterine cervix at 6 months after large loop excision of the transformation zone for cervical intraepithelial neoplasia. BJOG 119(6):678–684. https://doi.org/10.1111/j.1471-0528.2012.03275.xCrossRefPubMed

24.

Reich O, Lahousen M, Pickel H, Tamussino K, Winter R (2002) Cervical intraepithelial neoplasia III: long-term follow-up after cold-knife conization with involved margins. Obstet Gynecol 99(2):193–196. https://doi.org/10.1016/s0029-7844(01)01683-0CrossRefPubMed

25.

Pils S, Eppel W, Seemann R, Natter C, Ott J (2014) Sequential cervical length screening in pregnancies after loop excision of the transformation zone conisation: a retrospective analysis. BJOG 121(4):457–462. https://doi.org/10.1111/1471-0528.12390CrossRefPubMed

26.

Kalliala I, Anttila A, Dyba T, Hakulinen T, Halttunen M, Nieminen P (2012) Pregnancy incidence and outcome among patients with cervical intraepithelial neoplasia: a retrospective cohort study. BJOG 119(2):227–235. https://doi.org/10.1111/j.1471-0528.2011.03042.xCrossRefPubMed

27.

Kyrgiou M, Mitra A, Arbyn M, Paraskevaidi M, Athanasiou A, Martin-Hirsch PP et al (2015) Fertility and early pregnancy outcomes after conservative treatment for cervical intraepithelial neoplasia. Cochrane Database Syst Rev 2015(9):CD008478. https://doi.org/10.1002/14651858.CD008478.pub2CrossRefPubMedPubMedCentral

28.

Marzi J, Stope MB, Henes M, Koch A, Wenzel T, Holl M et al (2022) Noninvasive physical plasma as innovative and tissue-preserving therapy for women positive for cervical intraepithelial neoplasia. Cancers 14(8):1933. https://doi.org/10.3390/cancers14081933CrossRefPubMedPubMedCentral

29.

Pinder LF, Parham GP, Basu P, Muwonge R, Lucas E, Nyambe N et al (2020) Thermal ablation versus cryotherapy or loop excision to treat women positive for cervical precancer on visual inspection with acetic acid test: pilot phase of a randomised controlled trial. Lancet Oncol 21(1):175–184. https://doi.org/10.1016/S1470-2045(19)30635-7. (Epub 2019 Nov 14)CrossRefPubMed

Titel: How endocervicoscopy can impact obstetric outcomes in women undergoing LEEP for CIN2 + : a retrospective cohort analysis
verfasst von: Luigi Della Corte
Giada Lavitola
Giuseppe Bifulco
Publikationsdatum: 01.06.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 2/2023
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-023-07087-5

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