Abstract
Abstract
Background
There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment.
Objectives
To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment.
Search strategy
We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023.
Selection criteria
Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included.
Data collection and analysis
Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis.
Main results
There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51–3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26–3.74).
Conclusion
Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.
Funder
University of Western Macedonia
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,General Medicine
Reference45 articles.
1. Kyrgiou M, Athanasiou A, Kalliala IEJ, Paraskevaidi M, Mitra A, Martin-Hirsch PP, et al (2017) Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev 11(11):CD012847. https://doi.org/10.1002/14651858.CD012847
2. Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD et al (2012) The Lower Anogenital Squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the college of american pathologists and the American society for colposcopy and cervical pathology. J Low Genit Tract Dis 16(3):205–242. https://doi.org/10.1097/LGT.0b013e31825c31dd
3. Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO (2013) Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev 2013(12):CD001318. https://doi.org/10.1002/14651858.CD001318.pub3
4. NHSCSP: Colposcopy and Programme Management. Guidelines for the NHS Cervical Screening Programme. 3rd edition. NHSCSP Publication No. 20. NHSCSP, Sheffield, 2016.
5. Anderson MC, Hartley RB (1980) Cervical crypt involvement by intraepithelial neoplasia. Obstet Gynecol 55(5):546–550