Study on the feasibility of cervical excision procedure in excluding invasive cancer among patients at the age of ≥ 50
Objective To explore the feasibility of excluding invasive cancer in women aged ≥ 50 years old with HSIL diagnosed pathologically by colposcopic biopsy.Methods The clinical data of 833 cases ≥ 50 years old who were diagnosed HSIL by colposcopic biopsy in Peking University First Hospital from January 2013 to October 2023 were retrospectively summarized.The risk of invasive cancer after the cervical excision procedure was predicted,as while as margin status and ECC results of the residual cervical canal after the excision procedure.Results After cervical excision procedure,11.5％(96/833)of HSIL diagnosed by colposcopic biopsy can be detected as invasive cancer,accounting for 94.1％(96/102)of all invasive cancer diagnosed.Univariate analysis showed age before cervical excision procedure,high-grade cytology abnormality,HPV 16/18,high-grade colposcopic impression,ECC HSIL,final pathological grade HSIL of biopsy(CIN 3)were associated with the detection of invasive cancer after cervical resection treatment(all P＜0.05).Multivariate analysis showed the colposcopy impression(OR=5.43,P＜0.05)and ECC HSIL(OR=2.42,P＜0.05)were independent risk factors for detection of invasive cancer after the cervical excision procedure.After the cervical excision procedure,pathological results of HSIL+,high-grade ECC of residual cervical canal and positive margin status were all related to invasive cancer detected after hysterectomy(all P＜0.05).High-grade ECC of residual cervical canal was the independent risk factor for the detection of invasive cancer after hysterectomy(OR=9.00,P＜0.05).Conclusions For patients ≥ 50 years old who were diagnosed HSIL by colposcopic biopsy should be treated by cervical excision procedure,thus,94.1％invasive cancer can be detected.Those with high-grade margin status,especially residual cervical canal ECC results should be further treated by repeating excision procedure or total hysterectomy.
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