Hysterectomy for Treatment of CIN

Kesić,; Dokić, Milan; Atanacković, Jasmina; Milenković, S.; Kalezic, I; Vukovic, S.

doi:10.1097/00128360-200301000-00008

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…The high risk factors of HSIL with cervical invasive cancer include postmenopausal, lesions involved glands, lesion range ≥ 2 quadrants, lesions involving cervical canal [ 11 ]. In this study, we found that the rate of pathological upgrading after surgery was 7.9%, which is similar to earlier reported in the literature [ 5 – 7 ]. However, Through univariate and multivariate logistic regression analysis, we found that Glandular involvement, lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H were independent risk factors for postoperative pathological upgrading, which was slightly different from previous reports [ 11 , 12 ].…”

Section: Discussionsupporting

confidence: 91%

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Lei,

Zhang,

Zheng

et al. 2024

BMC Cancer

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Objective To identify the risk factors of cervical high-grade squamous intraepithelial lesion(HSIL) complicated with occult cervical cancer and standardize the management of initial treatment for HSIL. Method The clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading. Result 1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2–59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244–12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78–23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947–14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892–11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good. Conclusion There is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.

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Section: Discussionsupporting

confidence: 91%

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Lei,

Zhang,

Zheng

et al. 2024

BMC Cancer

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“…These data are slightly higher than the 12% reported in the literature. 4 One of the most recent studies 26 found an incidence of micro‐invasive carcinoma of 10.38% at the final histopathological analysis of hysterectomies performed for CIN 3. The finding of unexpected micro‐invasive or invasive cervical cancer in hysterectomy specimens could explain the reticence of some gynecologists to abandon hysterectomy for treating CIN, especially for women in post‐menopausal status or in those who do not desire further reproduction.…”

Section: Discussionmentioning

confidence: 99%

Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi‐institutional study

Ciavattini

Giuseppe

Marconi

et al. 2022

Intl J Gynecology & Obste

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Objective To analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN). Methods Multicentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro‐invasive neoplasia, sub‐total hysterectomy, or trachelectomy were excluded. Results A significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415–0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow‐up, a vaginal lesion was recorded in 5% of cases. Conclusion A significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling.

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“…Women with incompletely excised CIN 2/3 are at risk for cervical cancer. One study found an incidence of micro-invasive carcinoma of 10.38% in the final histopathological analysis of hysterectomies performed for CIN 3 [ 34 ]. Patients with positive margins may be considered for repeated conization or hysterectomy [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

Peng,

Liu,

Jiang

et al. 2023

BMC Women's Health

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Background This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. Methods This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. Results Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3–4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. Conclusions Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.

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Hysterectomy for Treatment of CIN

Cited by 9 publications

References 15 publications

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi‐institutional study

Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

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