The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease

Cuello, Mauricio; Espinosa, María E.; Orlandini, Elisa; Hwang, Du Y.

doi:10.1002/ijgo.12480

Cited by 9 publications

(9 citation statements)

References 22 publications

(53 reference statements)

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“…Such endocervical sampling right after LEEP was associated with higher predictive value 16 . Similarly, Cuello et al 17 . put forward that ECC results also served as an independent factor in predicting persistent/recurrent diseases, primarily when high‐grade lesions existed.…”

Section: Discussionmentioning

confidence: 95%

“…Such endocervical sampling right after LEEP was associated with higher predictive value. 16 Similarly, Cuello et al 17 put forward that ECC results also served as an independent factor in predicting persistent/recurrent diseases, primarily when highgrade lesions existed. In contrast, Cui et al 6 suggested that both top-hat and ECC procedures provided little prognostic insight in a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of treatment failure after top‐hat procedure in squamous intraepithelial lesion

Chen

Fan

Jiang

et al. 2020

J of Obstet and Gynaecol

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Aim The value of top‐hat procedure during loop electrosurgical excision procedure (LEEP) for squamous intraepithelial lesions had remained controversial. This study aimed to evaluate whether top‐hat specimens positive for cervical intraepithelial neoplasia (CIN) on histopathology can serve as an independent risk factor to predict treatment failure. Methods We reviewed the medical records of patients who underwent LEEP and top‐hat procedures in Peking University First Hospital between 2011 and 2016 and collected their follow‐up data until January 2019. We compared the pathological risk factor of treatment failure. Multivariate analysis was carried out to clarify the independent determinant of treatment failure. A Cox model was used to assess the influence of different variables on cumulative treatment failure rates. Results This study included 295 cases for short‐term treatment failure, and among them, 178 cases were used to study the long‐term. The presence of CIN in top‐hat was relevant to short‐term treatment failure (OR = 9.64, 95% CI 2.55–36.4) despite a clear margin. On multivariate analysis, top‐hat result (OR = 3.58, 95% CI 1.30–9.89), age ≥ 50 (OR = 10.2, 95%CI 3.64–28.3) and post‐treatment HPV 16/18 infection (OR = 2.35, 95%CI 1.19–4.63) were independent risk factors in predicting short‐term failure. In the Cox model, these factors were also associated with higher cumulative failure rates. Conclusion The current study supported the predictive value of top‐hat procedure in short‐term failure after LEEP. Typically, women with positive top‐hat need closer follow‐up despite their negative margin status. Older women with positive top‐hat findings and HPV 16/18 infections after the treatment suffer a higher risk of short‐term failure.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Predictors of treatment failure after top‐hat procedure in squamous intraepithelial lesion

Chen

Fan

Jiang

et al. 2020

J of Obstet and Gynaecol

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“…In the current study, we found that the overall residual disease/recurrence rate at 24 months following surgery was 9.5%, which was consistent with previous reports. The risk factors for persistence/recurrence include age over 45 years, positive resection margins, abnormal intraoperative ECC, persistent postoperative HR-HPV infection, abnormal cytology, and positive ECC following surgery [ 11 , 22 , 23 ]. Intraoperative ECC is generally recognized as indicative of the status of the endocervical margin.…”

Section: Discussionmentioning

confidence: 99%

“…It was previously reported that 31% of cases of recurrent/residual disease were diagnosed using ECC during the follow-up period following a LEEP [ 10 ]. There was another study which recognized ECC during LEEP surgery as an indicator of insider status, found that intraoperative ECC was one of the risk factors of post-LEEP recurrent/residual [ 11 ]. However, few studies reported the relationship between preoperative ECC and recurrent/residual HSIL after LEEP.…”

Section: Introductionmentioning

confidence: 99%

Analysis of outcomes following loop electrosurgical excision and clinical features of patients with cervical high-grade squamous intraepithelial lesions with abnormal preoperative endocervical curettage

Feng

Wei

et al. 2023

World J Surg Onc

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Objective The purpose of this study was to identify the clinical characteristics of patients with high-grade squamous intraepithelial lesions (HSIL) with abnormal endocervical curettage (ECC) and to evaluate the efficacy of abnormal preoperative ECC in predicting recurrence after a loop electrosurgical excision procedure (LEEP). Methods We retrospectively analyzed a total of 210 cases of histological HSIL in female patients diagnosed using cervical biopsy and/or indiscriminating ECC, and these included 137 cases with normal ECC and 63 cases with abnormal ECC. We also collected preoperative information and data on postoperative human papillomavirus (HPV) and histological outcomes within 2 years. Results The additional detection rate of HSIL using indiscriminating ECC was 5%. Patients with abnormal ECC were older (P < 0.001), predominantly menopausal (P = 0.001), had high-grade cytology (P = 0.032), a type 3 transformation zone (P = 0.046), and a higher proportion of HPV type 16/18 infection (P = 0.023). Moreover, age (odds ratio [OR] = 1.078, 95% confidence interval [CI] = 1.0325–1.1333, P = 0.003) and HPV 16/18 infection (OR = 2.082, 95% CI = 1.042–4.2163, P = 0.038) were independent risk factors for abnormal ECC. With an observed residual lesion/recurrence rate of 9.5% over the 24-month follow-up, we noted a 9.3% higher rate in the abnormal ECC group when compared with the normal ECC group. Abnormal preoperative ECC (OR = 4.06, 95% CI = 1.09–15.14, P = 0.037) and positive HPV at the 12-month follow-up (OR = 16.55, 95% CI = 3.54–77.37, P = 0.000) were independent risk factors for residual disease/recurrence. Conclusion Preoperative ECC was one of the risk factors for post-LEEP residual/recurrent HSIL, and detecting abnormal ECC when managing older patients or patients with HPV 16/18 infection during colposcopy is critical.

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“…ECC is an effective pathological examination method that has attracted increasing attention in recent years. Cuello et al [ 33 ] believe that ECC has irreplaceable value in the diagnosis of cervical lesions. In addition, a positive ECC result is a predictor of persistent/recurrent disease after LEEP treatment.…”

Section: Discussionmentioning

confidence: 99%

Practical Model for Residual/Recurrent Cervical Intraepithelial Lesions in Patients with Negative Margins after Cold-Knife Conization

Chen

Dong

Liu

et al. 2022

JCM

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Objective: This study aimed to identify reliable risk factors for residual/recurrent cervical intraepithelial lesions in patients with negative margins after cold-knife conization. Methods: A total of 2352 women with HSILs (high-grade squamous intraepithelial lesions) with negative margins who underwent cold-knife conization between January 2014 and December 2020 were included; in total, 1411 women were assigned to the development cohort, and 941 women were assigned to the validation cohort. Multivariate logistic regression was used to build four predictive models based on the different combinations of follow-up data (Model A: preoperative factors; Model B: first-follow-up data; Model C: second-follow-up data; Model D: data from both follow-ups). The accuracy, sensitivity, specificity, false-positive rate (FPR), false-negative rate (FNR), and area under the receiver operating characteristic curve (AUC) were evaluated on the validation cohort. The predictive power of risk factors was further validated using six machine learning algorithms. Results: Model D demonstrated the highest AUC of 0.91 (95% CI, 0.87 to 0.96) in the validation cohort, whereas Models A, B, and C achieved AUCs of 0.69 (95% CI, 0.59 to 0.78), 0.88 (95% CI, 0.80 to 0.95), and 0.89 (95% CI, 0.81 to 0.97) respectively. The six machine learning methods achieved consistent results. Kaplan-Meier (KM) survival curves demonstrated that our models could effectively stratify patients with all models (p < 0.05 for all models). Conclusion: Our model, which is based on preoperative and follow-up factors, can serve as a complementary screening procedure for the early detection or prediction of recurrence after cold-knife conization in HSIL patients.

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The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease

Cited by 9 publications

References 22 publications

Predictors of treatment failure after top‐hat procedure in squamous intraepithelial lesion

Predictors of treatment failure after top‐hat procedure in squamous intraepithelial lesion

Analysis of outcomes following loop electrosurgical excision and clinical features of patients with cervical high-grade squamous intraepithelial lesions with abnormal preoperative endocervical curettage

Practical Model for Residual/Recurrent Cervical Intraepithelial Lesions in Patients with Negative Margins after Cold-Knife Conization

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