Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials

Hecken, Julia M.; Rezniczek, Günther A.; Tempfer, Clemens B.

doi:10.3390/cancers14112670

Cited by 5 publications

(5 citation statements)

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“…All patients received HPV PCR testing and a colposcopic examination. Colposcopy-directed biopsies were taken as well as an endocervical curettage [30]. Depending on the histological and (control-)cytological result, as well as the result of the performed HPV PCR, patients were divided into three groups: patients with a high-grade intraepithelial lesion (CIN3) and a positive high-risk HPV test (CIN3 group), patients without an intraepithelial lesion and a positive high-risk HPV test (HPV group), and healthy controls (N = no intraepithelial lesion and negative HPV test).…”

Section: Methodsmentioning

confidence: 99%

A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia

Wittenborn,

Flasshove,

Kupec

et al. 2023

Diagnostics

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Background: This pilot study assesses the potential use of miRNAs in the triage of colposcopy patients with type 3 (nonvisible) cervical transformation zone (TZ). Type 3 TZ is a constitutional finding associated with many problems and controversies in colposcopy patient management. Here, we present miRNAs as a potential biomarker for the detection of CIN3 in these cases. Materials and methods: Cervical mucosa samples (CMS) were collected from patients presenting with T3 transformation zone during routine workup using the Cytobrush. Depending on the histological and cytological result, as well as the result of the routinely performed HPV PCR, patients were divided into three groups: patients with a high-grade intraepithelial lesion (CIN3) and a positive high-risk HPV test (CIN3 group), patients without an intraepithelial lesion and a positive high-risk HPV test (HPV group), and healthy controls (N = no intraepithelial lesion and negative HPV test). The cervical mucus samples included in the study were tested for their expression levels of distinct miRNAs using qPCR. Results: All investigated miRNAs were consistently detectable in every sample. The CMSs of histologically graded CIN 3 showed consistently high expression levels of all eight miRNAs, whereas the CMSs from healthy patients (N) show generally lower expression levels. However, CMSs from patients of the HPV group represented a very heterogeneous group. Conclusions: The data presented here can provide a solid basis for future research into a triage test for patients with a T3 transformation zone on the basis of commonly used clinical equipment.

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Section: Methodsmentioning

confidence: 99%

A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia

Wittenborn,

Flasshove,

Kupec

et al. 2023

Diagnostics

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“…In a previous systematic review on imiquimod in CIN, only two studies were included, which concluded that imiquimod was effective in treating low-grade squamous intraepithelial lesion (LSIL), but less effective than surgery. 15 In the present study, a primary objective was to assess the efficacy of topical imiquimod in high-grade CIN lesions compared with LLETZ or placebo. A secondary objective was to determine the clearance rate of human HPV infection after topical imiquimod treatment, compared with LLETZ treatment, as well as to evaluate side effects associated with all treatment modalities.…”

Section: Objectivesmentioning

confidence: 99%

“…We performed a systematic review and meta‐analysis to summarize the available evidence. In a previous systematic review on imiquimod in CIN, only two studies were included, which concluded that imiquimod was effective in treating low–grade squamous intraepithelial lesion (LSIL), but less effective than surgery 15 . In the present study, a primary objective was to assess the efficacy of topical imiquimod in high‐grade CIN lesions compared with LLETZ or placebo.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of topical imiquimod in high‐grade cervical intraepithelial neoplasia: A systematic review and meta‐analysis

Sande

Kengsakul

Koeneman

et al. 2023

Intl J Gynecology & Obste

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ObjectiveA major side effect of cervical excision for high‐grade cervical intraepithelial neoplasia (CIN) is premature birth. A non‐invasive treatment for reproductive age women is warranted. The aim of the present study was to determine the efficacy of topical imiquimod in the treatment of high‐grade CIN, defined as a regression to ≤CIN 1, and to determine the clearance rate of high‐risk human papillomavirus (hr‐HPV), compared with surgical treatment and placebo.MethodsDatabases were searched for articles from their inception to February 2023.The study protocol number was INPLASY2022110046. Original studies reporting the efficacy of topical imiquimod in CIN 2, CIN 3 or persistent hr‐HPV infections were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta‐analyses checklist.ResultsFive studies were included (n = 463). Histological regression to ≤CIN 1 was 55% in imiquimod versus 29% in placebo, and 93% in surgical treatment. Imiquimod‐treated women had a greater odds of histological regression to ≤CIN 1 than placebo (odds ratio [OR] 4.17, 95% confidence interval [CI] 2.03–8.54). In comparison to imiquimod, surgical treatment had an OR of 14.81(95% CI 6.59–33.27) for histological regression to ≤CIN 1. The hr‐HPV clearance rate was 53.4% after imiquimod and 66% after surgical treatment (95% CI 0.62–23.77).ConclusionsThe histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.

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“…A systematic analysis of 33 studies of diagnostic and therapeutic interventions involving 5935 women concluded that LEEP/ LLETZ should be performed under LA and with colposcopic magnification [2].…”

Section: Introductionmentioning

confidence: 99%

“…In einer systematischen Analyse von 33 Studien über diagnostische und therapeutische Interventionen mit 5935 Frauen wird geschlussfolgert, dass LEEP/LLETZ unter LA und unter kolposkopischer Vergrößerung erfolgen sollte [2].…”

Section: Introductionunclassified

Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic?

Freisleben,

Petzel,

Jülicher

et al. 2023

Geburtshilfe Frauenheilkd

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In Germany, treatment of HSIL or AIS of the uterine cervix by loop excision is performed almost exclusively under general anaesthesia (GA). International studies and guidelines show high acceptance of local anaesthesia (LA) due to hermeneutic, medical, and economic factors. We performed an observational comparative study aiming to prove advantages of local anaesthesia within the German health system.In a prospective observational study, patients diagnosed with HSIL or AIS of the uterine cervix were treated at the Institute for Cytology and Dysplasia, Berlin, by loop excision in 2021. We started with a feasibility study: 303 patients diagnosed with HSIL/AIS of the uterine cervix and her colposcopist answered an electronic questionnaire with respect to loop excision under LA.Since we found a high acceptance for LA in patients and colposcopists, we initiated a comparative study LA vs. GA: 322 patients underwent loop excision and selected their mode of anaesthesia: n = 206 LA vs. n = 116 GA. 114 patients of the feasibility study had to undergo loop excision and became part of the comparative study (n = 79 for the LA group, n = 35 for the GA group). All patients received a standardised questionnaire to document their pain score within 24 h after treatment on a visual analogue scale, i.e. VAS, between 0 and 100. 178 patients of the LA group and 80 patients of the GA group completed and returned the questionnaire and form the cohort for our comparison of LA vs. GA. With 191 of these 258 patients, i.e. 74%, a telephone survey was performed to ask for patient satisfaction and the rates of recurrence after a mean interval of 1 year post surgery. We postulate that there will be no clinically relevant significant difference in satisfaction and postoperative pain between patients in the LA group and the GA group.In the feasibility study, 90% (272 of 303) of patients diagnosed with HSIL or AIS were considered eligible for LA by their colposcopists. 75% (227 of 303) of patients were open to loop excision under LA.In the comparative study, 63 of 206 women of the LA group were interviewed preoperatively: 89% would accept a pain score above 20 during the procedure, 33% a pain score above 50 and 11% of max. 20. Postoperatively, the median VAS pain score for loop excision under local anaesthesia was 13.1 in 178 patients, and pain during injection of local anaesthesia was 20.9 (p < 0.001). The VAS pain score 20 minutes post surgery did not differ significantly between 178 patients after local anaesthesia versus 80 patients after general anaesthesia (p = 0.09). The surgeons estimated the patient’s pain significantly less than the patients themselves with an underestimate of −14.63 points on the VAS (p < 0.001).Within 7 days following loop excision under LA, 95.5% of 178 patients would choose local anaesthesia as their preferred method for a potential repeat loop excision, 8.8% of which would like additional painkillers, and 4.5% would choose general anaesthesia.In a telephone follow-up survey of 133 women from the LA group after a mean of 12 months post surgery, 97% were “satisfied” or “very satisfied” with the treatment carried out. For patient satisfaction and postoperative pain, no clinically relevant significant difference was seen between the LA and the GA group.The rate of secondary bleeding (6.7% vs. 8.1%, p = 0.72), recurrence of HSIL/AIS (3.6% vs. 5.2%, p = 0.62), and the distribution of the histopathological R status (R0 89.5% vs. 81.1%, p = 0.73; R1 5.3% vs.12.2%, p = 0.57, Rx 4.1% vs. 5.4%, p = 0.65) showed no significant difference when comparing the LA group versus the GA group.Following loop excision under local anaesthesia, more than 95% of patients would choose this method again for repeat surgery. One year post surgery, 97% of the patients were “satisfied” or “very satisfied” with the treatment under local anaesthesia. Offering local anaesthesia for loop excision to patients should be mandatory and included in current guidelines.

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Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials

Cited by 5 publications

References 50 publications

A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia

A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia

The efficacy of topical imiquimod in high‐grade cervical intraepithelial neoplasia: A systematic review and meta‐analysis

Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic?

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