The Clinical Value Of Assisted Endocervical Curettage During Loop Electrosurgical Excision Procedure In Diagnosing Persistent Cervical Lesions

Objective:To evaluate the feasibility of assisted endocervical curettage during loop electrosurgical excision procedure in predicting persistent cervical lesions,and to evaluate the accuracy of diagnosing persistent cervical lesions and the value of predicting persistent cervical lesions.Methods:The study included 176 patients who underwent ECC during LEEP for HSIL or worse diagnosis by cervical biopsy and/or ECC at the cervical clinic of the First Affiliated Hospital of Chongqing Medical University from September 2018 to November 2019.we Collected demographic,pathological and follow-up data.The Kappa test was used to check the consistency,and the?~2 test,Fisher’s test and logistic regression analysis were used to explore the correlationship between the predictors and the persistent disease after LEEP.Results:A total of 176 patients were included in this study,and 8.5%(15/176)of the patients’ECC samples failed.Among the remaining 161patients,the positive rate of assisted ECC during LEEP was only 25.5%(41/161),of which HSIL accounted for 22.4%(36/161).The positive rate of LEEP margin was 34.8%(56/161),of which HSIL accounted for 31.1%(50/161).Comparing the pathological results of assisted ECC during LEEP with the pathological results of cervical canal after hysterectomy,the consistency of the diagnosis of persistent endocervical diseases was midrange(0.7<Kappa≥0.4,P<0.05).Eighteen patients who was diagnosed as cervical cancer or adenocarcinoma in situ were excluded.A total of 143 patients were included in the follow-up analysis.And the residual rate of cervical lesions after LEEP was 11.9%(17/143).In univariate analysis,for people aged 50 years old or older,HSIL detected by LEEP margin and ECC during LEEP were significantly correlated with persistent cervical lesions(P<0.05),while pathological grade of LEEP were not correlated with persistent cervical lesions after LEEP(P>0.05).Residual rates of cervical lesions were 1.1%(1/90)in patients with negative assisted ECC during LEEP and negative margins,4.8%(1/21)in patients with negative assisted ECC during LEEP and positive margins,25%(3/12)in patients with positive assisted ECC during LEEP and negative margins,and 60%(12/20)in patients with positive assisted ECC during LEEP and positive margins.The difference was significant(P<0.001).In logistic regression analysis,only HSIL detected by ECC during LEEP was an independent risk factor for persistent cervical lesions(P<0.001,OR=14.554).In this study,the residual rate of endocervical diseases after LEEP was 9.8%(14/143).The positive ECC during LEEP and positive internal margin were significantly correlated with persistent endocervical diseases(P<0.05).Moreover,the residual rate of endocervical diseases was the highest in patients with positive ECC during LEEP and positive internal margin,which was 53.3%(8/15).Conclusion:In the diagnosis and treatment of cervical intraepithelial neoplasia,ECC during LEEP has a high sensitivity in predicting persistent cervical lesions.And ECC can directly obtain endocervical tissue.It is recommended to use ECC in the diagnosis and treatment of patients with cervical precancerous lesions.For people aged 50 years old or older,positive ECC during LEEP and positive margin were risk factors for persistent cervical lesions after LEEP.Moreover,HSIL detected by assisted ECC during LEEP was a more important predictor of persistent cervical lesions than LEEP margin.The positive ECC during LEEP and positive internal margin were important predictors of persistent endocervical diseases.It is recommended that assisted ECC during LEEP should be used to increase the detection of persistent endocervical diseases during the diagnosis and treatment of patients suspected of endocervical diseases.In this study,the residual rate of cervical lesions was highest in patients with positive ECC during LEEP and positive margins.It is recommended that clinicians should fully consider the risk of persistent preinvasive cervical lesions after LEEP and formulate individualized follow-up treatment plans or follow-up strategies.