Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal

Abstract Objective To evaluate the role of cervical cytology (Pap smear) in the diagnosis of cervical intraepithelial neoplasia 2 or greater (CIN2+), presented exclusively in the endocervical canal, the clinical-epidemiological characteristics of this lesion, the necessary length of canal to be removed to treat, and the rate of invasive lesion hidden in the endocervical canal. Methods Cross-sectional study, by database analysis, of patients with abnormal cytology (high-grade squamous intraepithelial lesion [HSIL]), without visible colposcopy lesion, submitted to loop electrosurgical procedure (LEEP) to evaluate the association of cytology results with the histological product of the conization, to identify the epidemiological characteristics of endocervical lesion and clinical evolution, using a pvalue< 0.05 and 95% CI. Results In 444 cases, the Pap smear sensitivity for CIN2+ diagnosis was 75% (95% CI: 69.8-79.7), specificity was 40% (95% CI: 30.2-49.5), and the prevalence rate of histological lesion was 73% (95% CI: 70.1-78.7). There was a higher prevalence of CIN2+ in women over 42 years old and invasive cancer in those over 56 years old (p<0.001), and it was necessary to remove 2.6 cm in length of the canal to reduce the chance of recurrence (p<0.006). The rate of invasive cancer was 2.7%. Conclusion Cytology was related to a high prevalence to histological lesion (73%) in the diagnosis of CIN2+ in the endocervical disease; older patients presented a higher relationship with histological lesions in the canal disease, and it was necessary to remove an average of 2.6 cm in length of the endocervical canal to avoid the persistence and progression of CIN. The rate of occult neoplasia in the endocervical canal was 2.7%.

摘要 目的：评估宫颈细胞学（巴氏涂片，Pap smear）对仅局限于宫颈管内的宫颈上皮内瘤变2级及以上（CIN2+）的诊断价值，分析该类病变的临床流行病学特征、治疗所需切除的宫颈管长度，以及宫颈管内隐匿性浸润性病变的发生率。方法：本研究为横断面数据库分析研究，纳入细胞学检查提示高级别鳞状上皮内病变（HSIL）、阴道镜检查未见明确病灶的患者，所有受试者均接受环形电切术（LEEP）行宫颈锥切治疗。以P<0.05、95%置信区间（CI）作为统计学检验标准，分析细胞学结果与锥切术后病理标本的相关性，明确宫颈管内病变的流行病学特征及临床转归。结果：共纳入444例患者，巴氏涂片对CIN2+的诊断灵敏度为75%（95%CI：69.8~79.7），特异度为40%（95%CI：30.2~49.5）；锥切术后病理提示宫颈管内病变的患病率为73%（95%CI：70.1~78.7）。年龄超过42岁的女性CIN2+患病率更高，而56岁以上人群浸润性宫颈癌的发生率更高（P<0.001）；需切除2.6cm的宫颈管长度以降低病变复发风险（P<0.006）。本研究中浸润性宫颈癌的检出率为2.7%。结论：针对宫颈管内病变的CIN2+诊断中，宫颈细胞学与术后病理检出的高病变率（73%）具有相关性；老年患者与宫颈管内病变的病理检出率关联更强，且需平均切除2.6cm的宫颈管长度以避免CIN病变持续进展。宫颈管内隐匿性肿瘤的发生率为2.7%。