Endocervical glandular involvement, multicentricity, and extent of the disease are features of high-grade cervical intraepithelial neoplasia

Güdücü, Nilgün; Sidar, Güliz; Başsüllü, Nuray; Türkmen, İlknur; Dünder, İlkkan

doi:10.1016/j.anndiagpath.2013.04.002

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…Kodampur et al, 16 in a cohort study of 309 women with high-grade CIN who underwent LEEP, confirmed the increased need for further intervention when there was endocervical glandular involvement ( p = 0.024), which is similar to our findings. Glandular involvement is closely related to HSIL, 17 and it was positively related to recurrence in the samples ( p = 0.019), which corroborates the findings of Güdücü et al, 18 who observed that glandular extension is more present in HG lesions, thus demanding greater care when monitoring these cases.…”

Section: Discussionsupporting

confidence: 87%

Evaluation of the p16 and Ki-67 Biomarkers as Predictors of the Recurrence of Premalignant Cervical Cancer Lesions after LEEP Conization

Leite

Tafuri

Costa³

et al. 2017

Rev Bras Ginecol Obstet

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Objective To evaluate the expressions of biomarkers p16 and K i -67 in low-grade (LG) or high-grade (HG) lesions, and to relate them to risk factors and the recurrence of these lesions. Methods A retrospective case-control study of 86 patients with LG and HG lesions who underwent a loop electrosurgical excision procedure (LEEP) between 1999 and 2004. The control group was composed of 69 women with no recurrence, and the study group, of 17 patients with recurrence. All patients were followed-up over a two-year period after surgery, and screened every six months, including cytology and colposcopy. Biopsy samples collected from LEEP were submitted to immunohistochemical analysis for p16 and K i -67. The statistical analysis was performed using the Statistical Package for the Social Sciences software (SPSS, IBM-SPSS, Inc., Chicago, IL, US), with a significant p < 0.05. Results The biomarkers p16 and K i -67, separately or combined, showed no relation to recurrence on the total analysis. However, evaluating specifically HG lesions, the positive expression (2þ and 3 þ ) of p16/K i -67 was associated with recurrence (0.010). In addition, p16 isolated was also more expressive in HG lesions (2þ and 3 þ , p ¼ 0.018), but it was unrelated to recurrence. Conclusion Proteins p16 and K i -67, both isolated and combined, are not reliable primary markers for the recurrence of cervical lesions in the majority of LG lesions. However, analyzing only the group with prior diagnosis of HG lesions, the expressions of p16 and of p16/K i -67 were associated with recurrence, and they may be useful in monitoring these cases. IntroductionThe search for markers to facilitate the diagnosis of diseases is a constant in scientific research to save resources, time and to prevent unnecessary treatments. Cervical cancer is the most common cancer among women in 45 countries of the world and, worldwide, 266 thousand women die of it each year; 1 it is preceded by cervical lesions that may or may not progress to invasion. They are associated with infection and with the persistence of the human papillomavirus (HPV) to progress to invasive carcinoma. 2 Through this process, the cells infected with high-risk oncogenic HPV alter the cell cycle, modifying the production of proteins p16 and K i -67. The most common treatment for high grade (HG) lesions is cervical cone resection using the loop electrosurgical excision procedure (LEEP). A major concern of the treatment is the recurrence of the lesion, as it may reappear without symptoms and more severely. Proteins p16 and K i -67 are, respectively, cell progression and proliferation markers. Protein p16 is a tumor suppressor from the Ink4a family that induces the hyperphosphorylation of the retinoblastoma protein (pRb), and has low expression in normal tissues.3 K i -67 is a nuclear protein present in cells during the active proliferation stage, but it is not expressed when cells are in the quiescent state. 3 The expression of both molecules simultaneously already denotes some problem in the cell c...

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Section: Discussionsupporting

confidence: 87%

Evaluation of the p16 and Ki-67 Biomarkers as Predictors of the Recurrence of Premalignant Cervical Cancer Lesions after LEEP Conization

Leite

Tafuri

Costa³

et al. 2017

Rev Bras Ginecol Obstet

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“…Previous studies reported that glandular involvement (GI) was closely related to postoperative recurrence of the LEEP, and the number of patients with high-grade lesions showing glandular involvement was 4 times higher than that of patients with low-grade lesions [28][29][30][31][32]. However, on the contrary, some studies have confirmed that GI status did not affect the residual lesions in patients after excision [33,34].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

Wang,

2024

BMC Women's Health

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Background The purpose of this study was to predict the risk factors for residual lesions in patients with high-grade cervical intraepithelial neoplasia who underwent total hysterectomy. Methods This retrospective study included 212 patients with histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2-3) who underwent hysterectomy within 6 months after loop electrosurgical excision procedure (LEEP). Clinical data (e.g., age, menopausal status, HPV type, and Liquid-based cytology test(LCT) type), as well as pathological data affiliated with endocervical curettage (ECC), colposcopy, LEEP and hysterectomy, were retrieved from medical records. A logistic regression model was applied to estimate the relationship between the variables and risk of residual lesions after hysterectomy. Results Overall, 75 (35.4%) patients had residual lesions after hysterectomy. Univariate analyses revealed that positive margin (p = 0.003), glandular involvement (p = 0.017), positive ECC (p < 0.01), HPV16/18 infection (p = 0.032) and vaginal intraepithelial neoplasia (VaIN) I-III (p = 0.014) were factors related to the presence of residual lesions after hysterectomy. Conversely, postmenopausal status, age ≥ 50 years, ≤ 30 days from LEEP to hysterectomy, and LCT type were not risk factors for residual lesions. A positive margin (p = 0.025) and positive ECC (HSIL) (p < 0.001) were identified as independent risk factors for residual lesions in multivariate analysis. Conclusions Our study revealed that positive incisal margins and ECC (≥ CIN2) were risk factors for residual lesions, while glandular involvement and VaIN were protective factors. In later clinical work, colposcopic pathology revealed that glandular involvement was associated with a reduced risk of residual uterine lesions. 60% of the patients with residual uterine lesions were menopausal patients, and all patients with carcinoma in situ in this study were menopausal patients. Therefore, total hysterectomy may be a better choice for treating CIN in menopausal patients with positive margins and positive ECC.

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“…Recently, Güdücü et. al reported that margin positivity was related with the extent of the disease 12 . In the current study, higher surgical margin positivity in EGI positive patients may be attributable to the expansion of the disease into stromal glands.…”

Section: Discussionmentioning

confidence: 99%

Effect of endocervical glandular involvement on residual and recurrent disease in patients with high grade cervical dysplasia

Erkılınç

Taylan

Temel

et al. 2018

Cukurova Medical Journal

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The aim of this study was to evaluate the effect of endocervical glandular involvement on residual and recurrent disease in high-grade cervical dysplasia. Material and Methods: Patients underwent Loop Electrosurgical Excision Procedure (LEEP) or Cold Knife Conization (CKC) between January 2015 and June 2016 were identified. Patients that had low grade lesions in conization specimens were excluded. The data were collected for age, menopausal status, cytology, colposcopic findings, conization procedure, HPV positivity and subtype, diameters of specimen, number of pieces, pathologic data including status of margins, endocervical glandular involvement (EGI) and recurrence. Prognostic effect of EGI on residual and recurrent disease were evaluated Results: Of 282 patients, 204 were eligible. Median age was 41 years in both groups. Age, menopausal status, cytology, diameters of specimen, number of pieces, colposcopy findings and conization procedure did not differ between groups.. Surgical margin positivity was higher in EGI positive group. HPV type 16 positivity was significantly higher in EGI positive patients. EGI was found to be the only prognostic factor for residual disease and was not a prognostic factor for recurrent disease. Conclusion: Our findings showed that EGI appears as a poor prognostic factor for residual disease but not for recurrence in patients with high-grade cervical dysplasia. Amaç: Bu çalışmanın amacı yüksek dereceli servikal displazide endoservikal gland tutulumunun rezidü ve recurrent hastalık üzerine etkisini araştırmaktır. Gereç ve Yöntem: Ocak 2015-Haziran 2016 tarihleri arasında loop electrosurgical excision procedure (LEEP) ya da soğuk konizasyon yapılan hastalar belirlendi. Konizasyon spesimeninde düşük dereceli displazisi bulunan olgular dışlandı. Yaş, menaposal durum, servikal sitoloji, kolposkopik bulgular, konizasyon işlemi, HPV pozitifliğ ve alt tipi, spesimen boyutları, endoservikal gland tutulumu, cerrahi sıırların durumu, ve rekürrens verileri hasta kayıtlarından elde edildi. Endoservikal gland tutulumunun rezidüel ve rekürren hastalık üzerindeki prognostic etkileri derğerlendirildi. Bulgular: 208 yüksek dereceli servikal displazisi bulunan olgudan 204'ü çalışmaya dahil edildi. Yaş, menaposal durum sitoloji, spesimen boyutları, çıkarılan parka sayısı, koloposkopik bulgular, ve konizasyon işlemi açısından gruplar arasında fark yoktu Cerrahi sınır pozitifliği gland tutulumu olan grupta daha fazlaydı. HPV 16 pozitifliği gland tutulumu olan grupta daha yüksek idi. Endoservikal gland tutulumu rezidü hastalık için prognostik faktör iken rekürrens için prognostic etksinin olmadğı bulundu. Sonuç: Çalışmamız endoservikal gland tutulumunun yüksek dereceli servikal displazide kötü prognostik faktör olduğu rekürrens için prognostik etkisinin olmadığı sonucuna varmıştır.

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Endocervical glandular involvement, multicentricity, and extent of the disease are features of high-grade cervical intraepithelial neoplasia

Cited by 10 publications

References 17 publications

Evaluation of the p16 and Ki-67 Biomarkers as Predictors of the Recurrence of Premalignant Cervical Cancer Lesions after LEEP Conization

Evaluation of the p16 and Ki-67 Biomarkers as Predictors of the Recurrence of Premalignant Cervical Cancer Lesions after LEEP Conization

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

Effect of endocervical glandular involvement on residual and recurrent disease in patients with high grade cervical dysplasia

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