Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis

Sao Paulo Medical Journal - Tập 130 Số 2 - Trang 119-125 - 2012
Caroline Alves de Oliveira1,2,3,4,5, Fábio Bastos Russomano1,2,3,4,5, Saint Clair Gomes6, Flávia de Miranda Corrêa1,2,3,7,5
1 vezes maior nas pacientes com margens
20,0001) e, em dois anos, chegou
3Hospital Federal de Bonsucesso, Bonsucesso, Rio de Janeiro, Brazil.
4Instituto Fernandes Figueira.
5TIPO DE
6Fundação Osvaldo Cruz, Brazil
7Instituto Nacional do Câncer, Brazil

Tóm tắt

CONTEXT AND OBJECTIVE: Even if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelial squamous lesions, one and two years after cervical electrosurgical excisional treatment with positive margins. DESIGN AND SETTING: Systematic review of the literature and meta-analysis at Instituto Fernandes Figueira. METHODS: This meta-analysis was on studies published between January 1989 and July 2009 that were identified in Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, ISI Web of Science and Sigle. Articles were selected if they were cohort studies on electrosurgical excisional treatment of high-grade squamous intraepithelial lesions with a minimum follow-up of one year, a histopathological outcome of persistence of these lesions and a small risk of bias. RESULTS: The search identified 7,066 articles and another 21 in the reference lists of these papers. After applying the selection and exclusion criteria, only four articles were found to have extractable data. The risk of persistence of high-grade intraepithelial lesions after one year was 11.36 times greater (95% confidence interval, CI: 5.529-23.379, P < 0.0001) in patients with positive margins and after two years, was four times greater (95% CI: 0.996-16.164), although without statistical significance. CONCLUSION: This meta-analysis confirms the importance of positive margins as an indicator of incomplete treatment after the first year of follow-up and highlights the need for appropriately chosen electrosurgical techniques based on disease location and extent, with close surveillance of these patients.

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Tài liệu tham khảo

2008, ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology, Obstet Gynecol., 112, 1419, 10.1097/AOG.0b013e318192497c

Lu CH, 2006, Prediction of persistence or recurrence after conization for cervical intraepithelial neoplasia III, Obstet Gynecol., 107, 830, 10.1097/01.AOG.0000206777.28541.fc

Tyler LN, 2007, Significance of margin and extent of dysplasia in loop electrosurgery excision procedure biopsies performed for high-grade squamous intraepithelial lesion in predicting persistent disease, Arch Pathol Lab Med., 131, 622, 10.5858/2007-131-622-SOMAEO

Park JY, 2007, Risk factors predicting residual disease in subsequent hysterectomy following conization for cervical intraepithelial neoplasia (CIN) III and microinvasive cervical cancer, Gynecol Oncol., 107, 39, 10.1016/j.ygyno.2007.05.014

Manchanda R, 2008, Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years, BJOG., 115, 1238, 10.1111/j.1471-0528.2008.01853.x

Ghaem-Maghami S, 2007, Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis, Lancet Oncol., 8, 985, 10.1016/S1470-2045(07)70283-8

2006, Nomenclatura Brasileira para Laudos Cervicais e Condutas Preconizadas: recomendações para profissionais de saúde [Brazilian Nomenclature for Cervical Cytology Reports and Guidelines], J Bras Patol Med Lab., 42, 351

van Hamont D, 2006, Long-term follow-up after large-loop excision of the transformation zone: evaluation of 22 years treatment of high-grade cervical intraepithelial neoplasia, Int J Gynecol Cancer., 16, 615, 10.1111/j.1525-1438.2006.00404.x

Moher D, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med., 6, e1000097, 10.1371/journal.pmed.1000097

Stroup DF, 2000, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group, JAMA., 283, 2008, 10.1001/jama.283.15.2008

Luesley D, 2010

Wright TC Jr, 2007, 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ, Am J Obstet Gynecol., 197, 340, 10.1016/j.ajog.2007.07.050

Grimes DA, 2002, Bias and causal associations in observational research, Lancet., 359, 248, 10.1016/S0140-6736(02)07451-2

Sacket DL, 2003, Prognóstico, 109

Petitti DB, 2000, Statistical methods in meta-analysis, 94

Chang DY, 1996, Prediction of residual neoplasia based on histopathology and margin status of conization specimens, Gynecol Oncol., 63, 53, 10.1006/gyno.1996.0277

Goya-Canino MM, 2006, Follow-up of high risk intraepithelial lesions after loop excision, Prog Obstet Ginecol., 49, 72

Gardeil F, 1997, Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III, Obstet Gynecol., 89, 419, 10.1016/S0029-7844(96)00505-4

Verguts J, 2006, Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation, BJOG., 113, 1303, 10.1111/j.1471-0528.2006.01063.x

Bodner K, 2002, Is therapeutic conization sufficient to eliminate a high-risk HPV infection of the uterine cervix?: A clinicopathological analysis, Anticancer Res., 22, 3733

Fletcher RW, 2006, Revisões sistemáticas, 240

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Sao Paulo Medical Journal

Tập 130 Số 2

119-125

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