Derya KILIÇ, Tolga GÜLER, Elif AVŞAROĞLU, Yeliz ARMAN KARAKAYA, Babür KALELİ, Erkan ALATAŞ

Elektrocerrahi ile eksizyon sonrası cerrahi sınır pozitif yüksek dereceli servikal intraepitelyal lezyon olgularında lezyonun persistansı ile ilişkili parametreler

Amaç: Yüksek dereceli servikal intraepitelyal lezyonların (HSIL) tedavisinde eksizyon sonrası cerrahi sınırda HSIL devamlılığı saptanır ise yeniden eksizyon veya 4-6 ay sonra kontrol seçenekleri gündeme gelmektedir. Ancak bu olgularda re-eksizyon materyalinde HSIL’ in sebat edip etmediğini öngörebilen parametreler henüz tanımlanmamıştır. Biz bu çalışmada lezyon persistansı ile ilişkili olabilecek klinik ve histopatolojik parametreleri değerlendirmeyi amaçladık. Yöntem: Elektrocerrahi ile eksizyonel tedavi sonrası cerrahi sınırda HSIL devamlılığı izlenen ve bu nedenle yeniden eksizyon yapılan olguların bilgileri retrospektif olarak taranmıştır. Hastaların sosyodemografik verileri, başvuru sırasındaki HPV (Human Papilloma Virus) tiplemesi (HPV tip 16/18 veya diğer yüksek riskli tipler), maksimal lezyon çapları, odak sayısı, yüksek dereceli lezyonun derecesi (CIN2 veya CIN3), eksizyonel materyalin maksimal çapı, cerrahi sınır durumu ve derecelendirilmesi (Grade 1: şüpheli veya rölatif olarak tam sınırda olan cerrahi sınır pozitifliği; Grade 2: belirgin cerrahi sınır pozitifliği) ile sonraki eksizyonel işlemde HSIL’in sebat edip etmemesi analiz için kayıt edilmiştir. Bulgular: Çalışma kriterlerine uyan toplamda 73 hasta belirlendi. Yeniden eksizyon yapılan hastaların 23 (%31.5) tanesinde yüksek dereceli lezyonun sebat ettiği saptandı. Sosyodemografik ve histopatolojik faktörler (yaş, menapoz, sigara kullanımı, başlangıçtaki yüksek riskli HPV tipi, eksizyonun büyüklüğü, histolojik tip (CIN2/ CIN3) lezyon büyüklüğü, lezyonun odak sayısı ve cerrahi sınır pozitifliğinin derecesi) incelendiğinde, rezidüel hastalığın saptandığı ve saptanmadığı gruplar arasında istatistiksel anlamlı farklılık saptanmadı (p=0.116, p=0.750, p=0.601, p=0.092, p=0.719, p=0.501, p=0.699, p=0.131, p=0.884, sırasıyla). Sonuç: Olguların yaklaşık üçte birinde re-eksizyon materyalinde HSIL’ in sebat ettiği saptanmıştır. Ancak ne klinik özellikler ne de ilk eksizyondaki patolojik bulgular ile lezyonun varlığı arasında anlamlı bir ilişki gösterilememiştir.

Anahtar Kelimeler:

Servikal kanser, Yüksek dereceli intraepitelyal neoplazi, Cerrahi sınır, Loop elektrocerrahi eksizyon prosedürü

Parameters associated with persistent disease after excisional treatment by electrosurgery in patients with high grade cervical intraepithelial lesion and positive surgical margin

Purpose: In the treatment of high-grade cervical intraepithelial lesions (HSIL), when HSIL is detected at the surgical margin after excision, re-excision or control after 4-6 months are the management options. However, the parameters that will determine in which patients HSIL will persist in the re-excision materials are not precisely defined. In this study, we aimed to evaluate the relationship between clinical and histopathological parameters, and the persistence of the lesion after electrosurgical excision. Materials and methods: The information of the patients in colposcopy unit who had HSIL at surgical margin after electrosurgical excisional treatment and were experience re-excision for this reason were retrospectively investigated. In addition, the sociodemographic data of the patients, HPV (Human Papilloma Virus) typing (HPV type 16/18 or other high risk types) at the time of admission, maximal lesion diameter, number of foci, degree of high-grade lesion (CIN2 or CIN3), maximal diameter of excisional material, surgical margin status and grading (Grade 1: suspicious or relatively borderline surgical margin positivity; Grade 2: significant surgical margin positivity), and persistence of HSIL in the subsequent excisional procedure were recorded for analysis. Results: 73 patients who met the inclusion criteria of the study were identified. High-grade lesions were found to persist in 23 (31.5%) patients who underwent re-excision. When sociodemographic and histopathological factors were analyzed (age, menopause, smoking, initial high-risk HPV type, size of excision, histological type (CIN2 / CIN3) lesion size, lesion focus number, and the degree of surgical margin positivity), no statistical significance was found between the groups with and without residual disease (p=0.116, p=0.750, p=0.601, p=0.092, p=0.719, p=0.501, p=0.699, p=0.131, p=0.884, respectively). Conclusions: HSIL persisted in approximately one third of the cases with positive surgical margin after re-excision. However, neither clinical features nor pathological findings at the first excision were found to be significantly correlated with persistence.

Keywords:

Cervical cancer, High-grade intraepithelial neoplasia, Surgical margin, Loop electrosurgical excision procedure,

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