THE CORRELATION OF CERVICAL INTRAEPITHELIAL NEOPLASIA 3 DETECTED BY CERVICAL PUNCH BIOPSIES WITH THE PATHOLOGIC RESULTS OF CONIZATION AND HYSTERECTOMY
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective To know the correlation of punch-biopsy proven cervical intraepithelial neoplasia (CIN) 3 with the results of cone and hysterectomy. Methods We reviewed the medical records from 1999 to 2008, retrospectively, at a single institution. We checked age, cone and hysterectomy biopsy results, preoperative cervical smear results as well as human papillomavirus results. Results There were 104 patients whose punch biopsy results were CIN 3. 59 (56.7%) patients underwent cone and 45 did hysterectomy after punch biopsies. Cone found 6.8% of cervical cancer. Among patients undergoing hysterectomy without cone, 8.9% had cervical cancers. There were a lot of inflammations, atypical squamous cells of unknown significance, low-grade squamous intraepithelial lesion done as a Pap results just before cone. The positive rate of HPV was 80.0%. There were 5.1% of underestimated and 6.8% of over-estimated results according to the cone results, and 6.7% of under-estimated and 8.9% of overestimated according to the hysterectomy results. Conclusion Through conization, 93.2% of the patients whose punch biopsy results were CIN 3 had CIN and did not need hysterectomy, and 6.8%had cervical cancers and might need further treatment. Through hysterectomy, 91.2% had CIN and might undergo overtreatment.
Abstract
Objective To know the correlation of punch-biopsy proven cervical intraepithelial neoplasia (CIN) 3 with the results of cone and hysterectomy. Methods We reviewed the medical records from 1999 to 2008, retrospectively, at a single institution. We checked age, cone and hysterectomy biopsy results, preoperative cervical smear results as well as human papillomavirus results. Results There were 104 patients whose punch biopsy results were CIN 3. 59 (56.7%) patients underwent cone and 45 did hysterectomy after punch biopsies. Cone found 6.8% of cervical cancer. Among patients undergoing hysterectomy without cone, 8.9% had cervical cancers. There were a lot of inflammations, atypical squamous cells of unknown significance, low-grade squamous intraepithelial lesion done as a Pap results just before cone. The positive rate of HPV was 80.0%. There were 5.1% of underestimated and 6.8% of over-estimated results according to the cone results, and 6.7% of under-estimated and 8.9% of overestimated according to the hysterectomy results. Conclusion Through conization, 93.2% of the patients whose punch biopsy results were CIN 3 had CIN and did not need hysterectomy, and 6.8%had cervical cancers and might need further treatment. Through hysterectomy, 91.2% had CIN and might undergo overtreatment.
참고문헌 (26)
- Ang MS, "Colposcopically directed biopsy and loop excision of the transformation zone. Comparison of histologic findings", J Reprod Med, 40, pp.167~170 (1995)
- Baldauf JJ, "An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy", Acta Obstet Gynecol Scand, 76, pp.468~473 (1997)
- Prendiville W, "Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia", Br J Obstet Gynaecol, 96, pp.1054~1060 (1989)
- Serafini M, "Diagnosis and treatment of cervical intraepithelial neoplasia grade 3: a registry-based study in the Romagna region of Italy (1986-1993)", Int J Epidemiol, 28, pp.196~203 (1999)
- Heatley MK, "The correlation between the grade of dyskaryosis on cervical smear, grade of cervical intraepithelial neoplasia (CIN) on punch biopsy and the final histological diagnosis on cone biopsies of the cervix", Cytopathology, 9, pp.93~99 (1998)
- Benedet JL, "Colposcopic accuracy in the diagnosis of microinvasive and occult invasive carcinoma of the cervix", Obstet Gynecol, 65, pp.557~562 (1985)
- Buxton EJ, "Colposcopically directed punch biopsy: a potentially misleading investigation", Br J Obstet Gynaecol, 98, pp.1273~1276 (1991)
- Barker B, "The correlation between colposcopically directed cervical biopsy and loop electrosurgical excision procedure pathology and the effect of time on that agreement", Gynecol Oncol, 82, pp.22~26 (2001)
- Costa S, "Independent determinants of inaccuracy of colposcopically directed punch biopsy of the cervix", Gynecol Oncol, 90, pp.57~63 (2003)
- Kim BG, "The effi cacy of cervical cone biopsy in the diagnosis of the cervical intraepithelial neoplasia", Korean J Gynecol Oncol Colposc, 1, pp.49~57 (1990)
- 송은섭, "인천 부천 지역에서의 자궁경부 상피내종양 3 환자의 수술적 치료의 변화에 대한 연구", Korean Journal of Obstetrics and Gynecology, 48(10), pp.2330~2335 (2005), 대한산부인과학회
- Denny LA, "Does colposcopically directed punch biopsy reduce the incidence of negative LLETZ", Br J Obstet Gynaecol, 102, pp.545~548 (1995)
- Spitzer M, "The use of large-loop excision of the transformation zone in an inner-city population", Obstet Gynecol, 82, pp.731~735 (1993)
- Massad LS, "Correlation between colposcopically directed biopsy and cervical loop excision", Gynecol Oncol, 60, pp.400~403 (1996)
- Vergote IB, "Laser excision of the transformation zone as treatment of cervical intraepithelial neoplasia with satisfactory colposcopy", Gynecol Oncol, 44, pp.235~239 (1992)
- Zuchna C, "Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen", Am J Obstet Gynecol, 203(321), pp.1~6 (2010)
- Killackey MA, "Diagnostic conization of the cervix: review of 460 consecutive cases", Obstet Gynecol, 67, pp.766~770 (1986)
- Chen RJ, "Independent clinical factors which correlate with failures in diagnosing early cervical cancer", Gynecol Oncol, 58, pp.356~361 (1995)
- Burger MP, "The reliability of the histologic diagnosis in colposcopically directed biopsies. A plea for LETZ", Int J Gynecol Cancer, 3, pp.385~390 (1993)
- Kirkup W, "The accuracy of colposcopically directed biopsy in patients with suspected intraepithelial neoplasia of the cervix", Br J Obstet Gynaecol, 87, pp.1~4 (1980)
- Chappatte OA, "Histological differences between colposcopic-directed biopsy and loop excision of the transformation zone (LETZ): a cause for concern", Gynecol Oncol, 43, pp.46~50 (1991)
- Howell R, "The histologic reliability of laser cone biopsy of the cervix", Obstet Gynecol, 77, pp.905~911 (1991)
- Robboy SJ, "Cut up: the gross description processing and reporting of specimens, In Pathology of the female reproductive tract", pp.861~908 (2002), Churchill-Livingstone
- Bonardi R, "Loop electrosurgical excision procedure of the transformation zone and colposcopically directed punch biopsy in the diagnosis of cervical lesions", Obstet Gynecol, 80, pp.1020~1022 (1992)
- Chenoy R, "The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy", Br J Obstet Gynaecol, 103, pp.457~462 (1996)
- Wetrich DW, "An analysis of the factors involved in the colposcopic evaluation of 2194 patients with abnormal Papanicolaou smears", Am J Obstet Gynecol, 154, pp.1339~1349 (1986)