Focused Ultrasound Versus the Loop Electrosurgical Excision Procedure to Treat Women with Cervical High-grade Squamous Intraepithelial Lesions Under 40: a Retrospective Study

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2024 Feb 3

PMID 38310208

Authors

Linlin Xiao

Xu Dong

Jiangchuan Sun

Xuerui Zhang

Qing Feng

Shufang Chang

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to compare the efficacy of focused ultrasound (FUS) and the loop electrosurgical excision procedure (LEEP) for the treatment of cervical high-grade squamous intraepithelial lesions (HSILs) among women of reproductive age.

Methods: Case records of patients aged < 40 years who were treated for cervical HSILs using either FUS or LEEP from September 1, 2020 to May 31, 2022 were retrospectively reviewed. Patients were followed up for cure, recurrence, human papillomavirus (HPV) clearance, and complications within 1 year of treatment. Odds ratios and 95% confidence intervals were determined using univariate and multivariate logistic regression models to analyze the association between disease evidence or HPV clearance and treatment modalities or other covariates.

Results: Of the 1,054 women who underwent FUS or LEEP, 225 met our selection criteria. Among the selected women, 101 and 124 received FUS and LEEP, respectively. There was no significant difference between the FUS and LEEP groups in the cure rate during the 3-6 months of follow-up (89.11% vs. 94.35%, P = 0.085) and recurrence rate during the 6-12 months follow-up (2.22% vs. 1.71%, P = 0.790). Both groups exhibited enhanced cumulative HPV clearance rates; however, the rates were not significantly different between the FUS and LEEP groups (74.23% vs. 82.79%, P = 0.122 during the 3-6 months follow-up; 84.95% vs. 89.17%, P = 0.359 during the 6-12 months follow-up). Furthermore, the incidence of complications caused by the FUS and LEEP techniques was comparable (5.0% vs. 5.6%, P = 0.818).

Conclusions: We found that FUS and LEEP have similar efficacy, safety, and reliability in treating women (aged < 40 years) with HSILs.

References

Bosch F, Lorincz A, Munoz N, Meijer C, Shah K . The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002; 55(4):244-65. PMC: 1769629. DOI: 10.1136/jcp.55.4.244. View

Brockmeyer A, Wright J, Gao F, Powell M . Persistent and recurrent cervical dysplasia after loop electrosurgical excision procedure. Am J Obstet Gynecol. 2005; 192(5):1379-81. DOI: 10.1016/j.ajog.2004.12.044. View

Rabasa J, Bradbury M, Sanchez-Iglesias J, Guerrero D, Forcada C, Alcalde A . Evaluation of the intraoperative human papillomavirus test as a marker of early cure at 12 months after electrosurgical excision procedure in women with cervical high-grade squamous intraepithelial lesion: a prospective cohort study. BJOG. 2019; 127(1):99-105. DOI: 10.1111/1471-0528.15932. View

Pinder L, Parham G, Basu P, Muwonge R, Lucas E, Nyambe N . Thermal ablation versus cryotherapy or loop excision to treat women positive for cervical precancer on visual inspection with acetic acid test: pilot phase of a randomised controlled trial. Lancet Oncol. 2019; 21(1):175-184. PMC: 6946855. DOI: 10.1016/S1470-2045(19)30635-7. View

Perkins R, Guido R, Castle P, Chelmow D, Einstein M, Garcia F . 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020; 24(2):102-131. PMC: 7147428. DOI: 10.1097/LGT.0000000000000525. View

Abdul-Karim F, Fu Y, REAGAN J, WENTZ W . Morphometric study of intraepithelial neoplasia of the uterine cervix. Obstet Gynecol. 1982; 60(2):210-4. View

Kitchener H, Walker P, Nelson L, Hadwin R, Patnick J, Anthony G . HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia. BJOG. 2008; 115(8):1001-7. DOI: 10.1111/j.1471-0528.2008.01748.x. View

Bogani G, Sopracordevole F, Ciavattini A, Vizza E, Vercellini P, Ghezzi F . HPV persistence after cervical surgical excision of high-grade cervical lesions. Cancer Cytopathol. 2023; 132(5):268-269. DOI: 10.1002/cncy.22760. View

Duan L, Yin H, Li Q, Zhou L, Mi X, Ju Y . Correlation between human papillomavirus infection and reproduction. Ginekol Pol. 2022; 93(4):329-333. DOI: 10.5603/GP.a2021.0175. View

10.

Qin Y, Li Q, Ke X, Zhang Y, Shen X, Wang W . Clearance of HR-HPV within one year after focused ultrasound or loop electrosurgical excision procedure in patients with HSIL under 30. Int J Hyperthermia. 2021; 39(1):15-21. DOI: 10.1080/02656736.2021.2010817. View

11.

Zhu L, Huang Y, Lam D, Gach H, Zoberi I, Hallahan D . Targetability of cervical cancer by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated hyperthermia (HT) for patients receiving radiation therapy. Int J Hyperthermia. 2021; 38(1):498-510. DOI: 10.1080/02656736.2021.1895330. View

12.

Giannini A, Di Donato V, Sopracordevole F, Ciavattini A, Ghelardi A, Vizza E . Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization. Vaccines (Basel). 2023; 11(3). PMC: 10051663. DOI: 10.3390/vaccines11030698. View

13.

Di Donato V, Bogani G, Casarin J, Ghezzi F, Malzoni M, Falcone F . Ten-year outcomes following laparoscopic and open abdominal radical hysterectomy for "low-risk" early-stage cervical cancer: A propensity-score based analysis. Gynecol Oncol. 2023; 174:49-54. DOI: 10.1016/j.ygyno.2023.04.030. View

14.

Singh A, Arthur B, Agarwal V . LEEP Verses Cryotherapy in CIN. J Obstet Gynaecol India. 2012; 61(4):431-5. PMC: 3295871. DOI: 10.1007/s13224-011-0048-1. View

15.

Martin-Hirsch P, Paraskevaidis E, Bryant A, Dickinson H . Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2013; (12):CD001318. PMC: 8958508. DOI: 10.1002/14651858.CD001318.pub3. View

16.

Liu Y, Wang W, Zhang M, Qu D, Du C, Chen Y . High-Intensity Focused Ultrasound for Patients With Cervical Intraepithelial Neoplasia 2/3: A Prospective One-Arm Study. Ultrasound Med Biol. 2022; 49(1):375-379. DOI: 10.1016/j.ultrasmedbio.2022.09.020. View

17.

Tan R, Xiao L, Sun J, Liu M, Zhang X, Chang S . A retrospective study of focused ultrasound versus cryotherapy in treatment of cervical squamous intraepithelial lesions. Int J Hyperthermia. 2022; 39(1):1294-1299. DOI: 10.1080/02656736.2022.2129104. View

18.

Vink M, Bogaards J, van Kemenade F, de Melker H, Meijer C, Berkhof J . Clinical progression of high-grade cervical intraepithelial neoplasia: estimating the time to preclinical cervical cancer from doubly censored national registry data. Am J Epidemiol. 2013; 178(7):1161-9. DOI: 10.1093/aje/kwt077. View

19.

Rema P, Suchetha S, Thara S, Fayette J, Wesley R, Sankaranarayanan R . Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting. Int J Gynaecol Obstet. 2008; 103(2):105-10. DOI: 10.1016/j.ijgo.2008.06.020. View

20.

Wang W, Yao Y, Liu Y, Ren J, Chen L, Wang Z . Focused ultrasound for high-risk human papillomavirus infection-related low-grade cervical lesions: a prospective cohort study. Int J Hyperthermia. 2022; 39(1):1327-1334. DOI: 10.1080/02656736.2022.2130443. View