目的:宫颈锥切术是治疗癌前病变的有效方法。然而,在手术标本中没有发现高级别病变的情况下,由于缺乏针对阴性锥形连接的既定随访方案,因此管理这些患者可能具有挑战性.本研究旨在通过组织病理学回顾评估我们机构的阴性锥化率,识别诊断错误,可能的风险和复发因素,并提出对该组患者的随访策略。
方法:2010年1月至2020年12月的一项回顾性研究分析了锥形锥切术阴性的患者,包括所有手术技术和手术指征。回顾了活检和宫颈锥形切片,对结果阴性的患者进行了更深层次的石蜡块切片,并应用了免疫组织化学染色:p16,Ki-67和geminin。将数据与由29名使用CIN3的女性组成的对照组进行比较。
结果:在1022个conizations中,186个为阴性(18.1%),在排除35例患者后,选择151例用于研究。病理检查后,4例患者因宫颈活检结果假阳性而被排除,16用于假阴性锥化结果,9用于深切片后发现的隐性发育不良。其余122例患者被认为是真正的阴性视锥细胞(11.9%),并且在20.4%的病例中表现出p16阳性的IHC染色,Ki-67低表达,和低Geminin分数在大多数情况下。CIN1标本p16染色患病率较高,Ki-67表达和geminin评分与无肿瘤相比,然而,geminin没有统计学差异。年纪大了,p16阴性、Ki-67和geminin表达较高的产次和IHC模式被确定为阴性视锥细胞的危险因素(p<0.05)。只有10名患者因高级别病变复发,没有发现统计学上显著的危险因素。
结论:锥化阴性率为11.9%,通过手术前活检发现的诊断错误,锥形试样,更深层次。危险因素包括年龄较大,更高的奇偶校验,p16、Ki-67和geminin的低表达(p<0.05)。复发占负锥体的8.1%,没有识别统计学上显著的危险因素。对于锥化阴性的患者,建议进行更深层次的病理检查和2年的随访。
OBJECTIVE: Cervical conization is an effective treatment for precancerous lesions. However, in cases where no high-grade lesion is identified in the surgical specimen, managing these patients may be challenging due to the absence of established follow-up protocols for negative conizations. This study aimed to assess the negative conization rates at our institution by histopathological review, identify diagnostic errors, possible risk and recurrence factors and propose follow-up strategies for this group of patients.
METHODS: A retrospective study from January-2010 to December-2020 analyzed patients with negative conization including all surgical techniques and procedure indications. Biopsy and cervical conizations slides were reviewed and patients who kept a negative result underwent deeper levels sectioning of the paraffin blocks with immunohistochemical stains application: p16, Ki-67 and geminin. Data were compared with a control group composed by 29 women with CIN3.
RESULTS: Out of 1022 conizations, 186 were negative (18.1%), with 151 cases selected for the study after excluding 35 patients. Following pathology review, 4 patients were excluded due to false-positive cervical biopsy results, 16 for false-negative conization results and 9 for hidden dysplasia identified after deeper sectioning. The remaining 122 patients were considered truly negative cones (11.9%) and exhibited IHC staining with p16 positive in 20.4% of cases, low Ki-67 expression, and low geminin score in most cases. Specimens with CIN 1 had higher prevalence of p16 staining, Ki-67 expression and geminin score when compared to absence of neoplasia, nevertheless geminin had no statistical difference. Older age, higher parity and IHC pattern with negative p16, low Ki-67 and geminin expressions were identified as risk factors for negative cones (p<0.05). Only 10 patients recurred for high-grade lesions, with no statistically significant risk factors identified.
CONCLUSIONS: The negative conization rate was 11.9%, with diagnostic errors identified across pre-surgical biopsy, cone specimen, and deeper levels. Risk factors included older age, higher parity, low expression of p16, Ki-67 and geminin (p<0.05). Recurrence represented 8.1% of the negative cones, without identification of statistically significant risk factors. Pathological review with deeper level sections and 2-year follow-up are recommended for patients with negative conizations.