Vol 94, No 1 (2023)
Research paper
Published online: 2022-08-23

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Histopathological discrepancies between colposcopy-directed biopsy and LEEP-conization observed during SARS-CoV-2 pandemic

Dominik Pruski12, Marcin Przybylski13, Sonja Millert-Kalinska41, Andrzej Zmaczynski5, Robert Jach5
Pubmed: 36043301
Ginekol Pol 2023;94(1):12-18.

Abstract

Objectives: Long-term exposure to the human papillomavirus (HPV) is a known cause of squamous intraepithelial lesions that lead to cervical cancer. The loop electrosurgical excision procedure (LEEP) conization is an established treatment method. According to the latest recommendations, we present a paper to evaluate the effectiveness of various diagnostic methods of squamous intraepithelial lesions. Material and methods: We analyzed 229 patients who reported to District Public Hospital in Poznan to undergo LEEP conization in 2019–2021 during the SARS-CoV-2 Pandemic. The analysis included Pap smear/liquid-based cytology, HPV genotyping, colposcopy with targeted biopsy and LEEP-conization. We offered post-treatment HPV vaccination and, as a follow-up, performed HPV re-genotyping after six months. Results: In total, 89.1% of patients were HPV-positive. The coloscopy-directed biopsy (CDB) results show that almost 70% of the patients had high-grade intraepithelial lesions (HSIL). The diagnosis obtained by LEEP-conization showed that half of the women were diagnosed with HSIL and one-third with the low-grade squamous intraepithelial lesion (LSIL). The sensitivity of Pap smear/LBC accounted for 93.7% and was lower than for CDB, which reached 95.1%. Both diagnostic methods tend to underestimate the final diagnosis. Conclusions: The inclusion of a colposcopic examination in an in-depth diagnostic process in women with abnormal Pap smear results facilitates the identification of patients requiring therapeutic intervention. LEEP-conization may be used without the primary biopsy. It applies to multiparous women in the perimenopausal period, extensive abnormalities, discrepancies in test results, extensive visible abnormalities, and suspicion of invasive cervical cancer in the colposcopic examination.

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References

  1. Ferlay JEM, Lam F, Colombet M, et al. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer. A Cancer Journal for Clinicians. Published online 2020.
  2. Massad L, Einstein M, Huh W, et al. 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Obstetrics & Gynecology. 2013; 121(4): 829–846.
  3. WHO. WHO EB recommends the adoption of the strategy for elimination of cervical cancer. WHO.
  4. World Health Organization. Global Strategy towards eliminating cervical cancer as a public health problem. WHO press, Published online 2020.
  5. Gultekin M, Ramirez PT, Broutet N, et al. World Health Organization call for action to eliminate cervical cancer globally. Int J Gynecol Cancer. 2020; 30(4): 426–427.
  6. Jach R, Mazurec M, Trzeszcz M, et al. COLPOSCOPY 2020 - COLPOSCOPY PROTOCOLS: A Summary of the Clinical Experts Consensus Guidelines of the Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynaecologists and Obstetricians. Ginekol Pol. 2020; 91(6): 362371.
  7. Jach R, Mazurec M, Trzeszcz M, et al. COLPOSCOPY PROTOCOLS 2020. Ginekol Pol. 2020; 91(6): 362371–362371.
  8. Jach R, Mazurec M, Trzeszcz M, et al. Cervical cancer screening in Poland in current SARS-CoV-2 pandemic: Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology - a summary January 2021. Ginekol Pol. 2021; 92(2): 165–173.
  9. Duesing N, Schwarz J, Choschzick M, et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012; 286(6): 1549–1554.
  10. Kabaca C, Koleli I, Sariibrahim B, et al. Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia? J Low Genit Tract Dis. 2014; 18(3): 240–245.
  11. Jung Y, Lee AhRa, Lee SJ, et al. Clinical factors that affect diagnostic discrepancy between colposcopically directed biopsies and loop electrosurgical excision procedure conization of the uterine cervix. Obstet Gynecol Sci. 2018; 61(4): 477–488.
  12. Shrestha B, Malla Vaidya K, Joshi R. Evaluation of Visual Inspection of Cervix with Acetic Acid and Liquid Based in Cervical Cancer Screening with Cervical Biopsy. J Nepal Health Res Counc. 2020; 18(3): 426–430.
  13. Khan M, Sultana SS, Jabeen N, et al. Visual inspection of cervix with acetic acid: a good alternative to pap smear for cervical cancer screening in resource-limited setting. J Pak Med Assoc. 2015; 65(2): 192–195.
  14. Vallapapan A, Chandeying N, Srijaipracharoen S, et al. The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2. J Obstet Gynaecol. 2019; 39(2): 184–189.
  15. Pruski D, Kedzia W, Przybylski M, et al. [Assesment of real optoelectronic method in the detection of cervical intraepithelial neoplasia]. Ginekol Pol. 2008; 79(5): 342–346.
  16. Booth BB, Petersen LK, Blaakaer J, et al. Can the dynamic spectral imaging (DSI) color map improve colposcopy examination for precancerous cervical lesions? A prospective evaluation of the DSI color map in a multi-biopsy clinical setting. BMC Womens Health. 2021; 21(1): 21.
  17. Ferenczy A, Choukroun D, Arseneau J. Loop electrosurgical excision procedure for squamous intraepithelial lesions of the cervix: advantages and potential pitfalls. Obstet Gynecol. 1996; 87(3): 332–337.
  18. Kyrgiou M, Tsoumpou I, Vrekoussis T, et al. The up-to-date evidence on colposcopy practice and treatment of cervical intraepithelial neoplasia: the Cochrane colposcopy & cervical cytopathology collaborative group (C5 group) approach. Cancer Treat Rev. 2006; 32(7): 516–523.
  19. Wright TC, Massad LS, Dunton CJ, et al. 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference, 2006 ASCCP-Sponsored Consensus Conference, 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference, 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol. 2007; 197(4): 340–345.
  20. Numnum TM, Kirby TO, Leath CA, et al. A prospective evaluation of "see and treat" in women with HSIL Pap smear results: is this an appropriate strategy? J Low Genit Tract Dis. 2005; 9(1): 2–6.
  21. Kim SeIk, Kim SeJ, Suh DH, et al. Pathologic discrepancies between colposcopy-directed biopsy and loop electrosurgical excision procedure of the uterine cervix in women with cytologic high-grade squamous intraepithelial lesions. J Gynecol Oncol. 2020; 31(2): e13.
  22. Zhang Lu, Li Q, Zhao M, et al. Discrepancies between biopsy-based and excision-based grading of cervical intraepithelial neoplasia: the important role of time between excision and biopsy. Int J Gynecol Pathol. 2015; 34(3): 221–227.
  23. Dunn TS, Burke M, Shwayder J. A "see and treat" management for high-grade squamous intraepithelial lesion pap smears. J Low Genit Tract Dis. 2003; 7(2): 104–106.