Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact

Abstract

IntroductionAfter the diagnosis of L-SIL, 77. 3% had a persistent infection and anomalous Pap Test results. Many of these patients had highlighted psychological consequences such as anxiety, hypochondria, fear of cancer, and sexual problems. Several studies suggested that the clearance of HR-HPV infection could be accelerated by cervical excisional procedures, especially in L-SIL. In consideration of the psychological implications for HPV infection and related dysplasia in patients with CIN1 at PAP-smear and HR-HPV positivity at least for 6 months, we decided to plan a prospective study where we tried to anticipate excisional cervical using a minimally invasive treatment: thin loop electrosurgical excision procedure (t-LEEP). This study aims to analyze the clearance of HR-HPV after 6 and 12 months, clinical outcomes related to t-LEEP, and the psycho-relational impact at 12 months after t-LEEP.Materials and MethodsWe enrolled patients with the diagnosis of L-SIL at PAP-smear and HR-HPV positivity with a persistent CIN 1 (at least for 6 months), confirmed by cervical biopsy. All enrolled patients underwent t-LEEP. We followed prospectively and performed for all patients the HPV DNA test at 6 (T1) and 12 months (T2) and STAI-Y and FSFI scores at T0 and T2.ResultsWe prospectively enrolled 158 patients, 22 are excluded for the established criteria. Patients with HR-HPV and CIN 1 lesions treated with t-LEEP had an overall clearance of 83.8% at T2. In subgroups analysis at T2, we had a regression: in smoker 71.8%, in contraceptive users 69.5%, in patients aged <25 years 100%, aged 25–30 years 85%, aged 30–35 years 94.4%, aged 35–40 years 92%, and aged ≥40 years 89.1%, in HPV-16 96.4%, in HPV-53 89.5%, in HPV-18 87.5%, in HPV-31 86.6%, and in coinfected 3.5%. STAI-Y and FSFI after t-LEEP (T2) were statistically significant, reducing anxiety status and improving sexual function.ConclusionBased on these results, the use of t-LEEP in patients with persistent CIN 1 and HPV-HR at least for 6 months could be useful for accelerating HPV-HR clearance, in particular, for a subpopulation patient with an increased risk of progression and/or patients with psychological and sexual consequences of carrying an HR-HPV infection.

The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review

“…The participants involved in the research had an abnormal cytology result or had received an HPV-positive test result. In order to understand the impact of an abnormal cytology result, HPV infection, and subsequent medical interventions on women’s mental health and sexual life, participants were screened and examined according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, using the Hospital Anxiety and Depression Scale (HADS) [ 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], Beck Depression Inventory (BDI) [ 29 , 30 ], Beck Anxiety Inventory (BAI) [ 29 , 30 , 31 ], Symptom Checklist-Revised (SCL-90) [ 32 ], Psychosocial Effects of Abnormal Pap Smears Questionnaire short-form (PEAPS-Q) [ 11 , 24 , 33 , 34 , 35 ], State-Trait Anxiety Inventory (STAI) [ 6 , 7 , 8 , 9 , 10 , 11 , 16 , 33 , 35 , 36 , 37 , 38 , 39 , 40 ], Female Sexual Function Index (FSFI) [ 15 , 17 , 31 , 39 , 41 , 42 ], HPV Impact Profile (HIP) [ 7 , 9 , 21 , 25 <...…”

“…The observational studies were classified using the ROBINS-E tool. Fourteen of the fifty-six included studies were rated as ‘low risk of bias’ [ 10 , 13 , 15 , 22 , 24 , 25 , 26 , 29 , 30 , 34 , 36 , 40 , 47 , 48 ], sixteen as ‘some concerns’ [ 8 , 9 , 11 , 14 , 17 , 19 , 32 , 39 , 44 , 49 , 52 , 53 , 54 , 55 , 56 , 67 ], twenty as ‘high risk’ [ 6 , 7 , 16 , 27 , 31 , 33 , 35 , 38 , 41 , 42 , 43 , 45 , 46 , 50 , 51 , 57 , 58 , 59 , 60 , 61 ], and five as ‘very high risk’ [ 62 , 63 , 64 ...…”

“…Seven of these were quantitative studies using validated instruments to assess mental state and sexual function, while three were qualitative studies. Most of these (8/10) studies were of good quality (‘low risk of bias’/‘some concerns’) [ 13 , 14 , 15 , 17 , 24 , 30 , 39 , 55 ], and two were assessed as ‘high risk of bias’ [ 16 , 42 ]. Four studies addressed the issue of mental health after the LEEP procedure [ 15 , 24 , 30 , 62 ], of which only one study found a negative effect of LEEP on anxiety symptoms [ 30 ] (1/4, 25%), while 75% (3/4) did not confirm these findings [ 15 , 24 , 39 ].…”

“…Most of these (8/10) studies were of good quality (‘low risk of bias’/‘some concerns’) [ 13 , 14 , 15 , 17 , 24 , 30 , 39 , 55 ], and two were assessed as ‘high risk of bias’ [ 16 , 42 ]. Four studies addressed the issue of mental health after the LEEP procedure [ 15 , 24 , 30 , 62 ], of which only one study found a negative effect of LEEP on anxiety symptoms [ 30 ] (1/4, 25%), while 75% (3/4) did not confirm these findings [ 15 , 24 , 39 ]. In total, six out of 10 studies, or 60% (5/7, 71% of quantitative studies and 1/3, 33% of qualitative studies), did not confirm a negative impact of the LEEP procedure on sexual functions [ 14 , 15 , 16 , 17 , 24 , 39 ], while four studies, or 40% (2/7, 28% of quantitative studies and 2/3, 67% of qualitative studies), found such an association [ 13 , 30 , 42 , 55 ].…”

“…Four studies addressed the issue of mental health after the LEEP procedure [ 15 , 24 , 30 , 62 ], of which only one study found a negative effect of LEEP on anxiety symptoms [ 30 ] (1/4, 25%), while 75% (3/4) did not confirm these findings [ 15 , 24 , 39 ]. In total, six out of 10 studies, or 60% (5/7, 71% of quantitative studies and 1/3, 33% of qualitative studies), did not confirm a negative impact of the LEEP procedure on sexual functions [ 14 , 15 , 16 , 17 , 24 , 39 ], while four studies, or 40% (2/7, 28% of quantitative studies and 2/3, 67% of qualitative studies), found such an association [ 13 , 30 , 42 , 55 ]. Some participants reported that symptoms of dyspareunia and postcoital bleeding, which indirectly affected sexual health, showed significant improvement post-LEEP procedure [ 14 ].…”