Features Predictive of Negative Excision Findings in Patients with Biopsy Diagnosis of HSIL (CIN II-III)
Ninad Patil, Khushbakhat Mittal. NYU School of Medicine, New York, NY
Background: Patients with cervical high grade dysplasia (HGD) usually undergo a cone/LEEP for excision. However, frequently the excision shows only low grade dysplasia (LGD) or no dysplasia. There is a small but possible chance of complications with these excision procedures, including cervical insufficiency, stenosis, bleeding or infection. We aimed to examine additional morphologic features in cervical biopsies with HGD, that may predict lack of HGD in excisions. This may potentially allow a more conservative approach in these patients.
Design: 51 consecutive cone biopsies/LEEPs from 2010 were selected from files after IRB approval. Previous cervical biopsies and ECCs which led to these excisions were reviewed for the following features: Number of biopsies with HGD, grade, proportion of biopsies with HGD, ECC with HGD, Cytology findings, Proportion of squamous epithelium with HGD, negative biopsy edges, presence of endocervix/exocervix, suboptimal epithelial orientation on biopsy, severe inflammation, condyloma with marked nuclear atypia and patients age.
Results: Out of the 51 patients, 38 had undergone excision procedure directly indicated by HGD on colposcopic biopsy. The rest had undergone the procedure due to cytology or other indications. Out of 38 patients, 25 (66%; positive excision group) showed HGD on excision while 13 (34%; negative excision group) showed LGD or negative excision. 23.8% (5/21) of biopsies with >10% epithelial involvement with HGD showed negative excision. In contrast, 47% (8/17) of biopsies with <10% epithelial involvement showed negative excision. Using Fisher's exact test, one sided p value is 0.12. Also, in the negative excision group, 46% (6/13) cases had the highest biopsy CIN grade of 2. In the positive excision group, only 28% (7/25) cases had highest biopsy CIN grade of 2. Other examined criteria, such as presence of severe inflammation, marked nuclear atypia, patient age, presence of transformation zone and involvement of biopsy edges showed roughly equal distribution between both groups. The average patient age in either group was 37.3 years.
Conclusions: The percentage involvement of squamous epithelium, with a cutoff of 10%, and the highest CIN grade on biopsy show trends for predicting presence or absence of high grade dysplasia on Cone/LEEP excision. A larger study set may possibly establish the significance of these trends. It is worthwhile to convey the percentage involvement and grade of dysplasia on a 3-tier system in cervical biopsy reports, so that the gynecologist can weigh the risks or benefits of an excisional procedure.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 219, Tuesday Afternoon