Current understanding of predictors and methods for preventing recurrent cervical intraepithelial neoplasia after loop electrosurgical excision procedure


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

One of the main cervical diseases that can be dangerous to a woman’s life is cervical cancer, and its incidence increases every year. High-grade cervical intraepithelial neoplasia (CIN2-3) may precede the development of cervical cancer for several years or even decades. In clinical practice, loop electrosurgical excision procedure (LEEP) has proven to be the most effective method for treating CIN which makes it possible to preserve the functional integrity of the cervix. The article presents a systematic analysis of the results of modern clinical studies devoted to the problem of the development of recurrent CIN after LEEP. This study considers the role of the carriage and persistence of human papillomavirus (HPV), especially HPV16, the age of a woman, and the presence of a positive resection margin in the development of recurrent CIN. The patient undergoes histological examination with the interpretation of its results and dynamic monitoring of the state of the cervix after LEEP. Moreover, HPV vaccination is currently considered by a number of authors as a possible method for preventing the development of recurrent CIN after surgical treatment. The timely detection of opportunistic mixed infections associated with squamous intraepithelial lesions of the cervix is also of great importance. Therefore, the results of studies on the effectiveness and safety of the use of the combined preparation Terzhinan for the treatment of mixed genital infections were analyzed. Conclusion. Despite the high effectiveness of LEEP in the treatment of CIN 2+, the management of women with this pathology requires a comprehensive approach. The predictors of recurrence include the age of a woman over 35 years, the carriage and persistence of HPV, the positive resection margin after excision, and the lack of the subsequent monitoring of the state of the cervix. HPV vaccination should be considered as one of the most effective methods for preventing the development of recurrent CIN.

Full Text

Restricted Access

About the authors

Vera N. Prilepskaya

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: vprilepskaya@mail.ru
Honored Scientist of the Russian Federation, Dr.Med.Sci, professor, Head of the Scientific and Polyclinic Department

Guldana R. Bairamova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: bayramova@mail.ru
Dr.Med.Sci, Professor of the Department of Obstetrics and Gynecology of the Department of Professional Education

Aleksandra V. Asaturova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_asaturova@oparina4.ru
Dr.Med.Sci., Head of the 1st Pathology Department

Alexander O. Andreyev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: sasha.grash20l0@yandex.ru
2-year clinical resident, specialty Obstetrics and Gynecology

Anastasiia V. Peremykina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nodushkina@mail.ru
сandidate, specialty Obstetrics and Gynecology

Veronika A. Pronina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ver22595@yandex.ru
2-year clinical resident, specialty Obstetrics and Gynecology

References

  1. Каприн А.Д., Старинский В.В., Петрова Г.В., ред. Состояние онкологической помощи населению России в 2018 г. М.: МНИОИ им. П.А Герцена -филиал ФГБУ "НМИРЦ" Минздрава России; 2019. [Kaprin A.D., Starinskiy V.V., Petrova G.V., eds. The state of cancer care for the population of Russia in 2018. Moscow: MNIOI im.P.A. Gertsena - filial FGBU "NMIRTs" Minzdrava Rossii; 2019. (in Russian)].
  2. Серов В.Н., Сухих Г.Т., Прилепская В.Н., Радзинский В.Е., ред. Руководство по амбулаторно-поликлинической помощи в акушерстве и гинекологии. 2-е изд. М.: ГЭОТАР-Медиа; 2016. 1136c. [Guidelines for outpatient care in obstetrics and gynecology. Ed.: V.N. Serov, G.T. Sukhikh, V.N. Prilepskaya, V.E. Radzinsky, 2nd ed., Revised. and add. M.: GEOTAR-Media; 2016.1136 p. (in Russian)].
  3. Клинические рекомендации Министерства здравоохранения Российской Федерации «Цервикальная интраэпителиальная неоплазия, эрозия и эктропион шейки матки». М.; 2020. [Clinical guidelines of the Ministry of Health of the Russian Federation «Cervical intraepithelial neoplasia, erosion and ectropion of the cervix». Moscow, 2020. (in Russian)].
  4. Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., Манухин И.Б., ред. Гинекология. Национальное руководство. 2-е изд. М.: ГЭОТАР-Медиа; 2017. [National guidelines for gynecology. Ed.: G.M. Savelyeva, G.T. Sukhikh, V.N. Serov, V.E. Radzinsky, I.B. Manukhin, 2nd ed., Revised and enlarged, 2017. (in Russian)].
  5. Прилепская В.Н., Сухих Г.Т., ред. Диагностика, лечение и профилактика цервикальных интраэпителиальных неоплазий. М.: МЕДпресс-информ; 2020. 80с. [Diagnostics, treatment and prevention of cervical intraepithelial neoplasias. Ed.: V.N. Prilepskaya and G.T. Sukhikh. M.: "MEDpress-inform", Moscow, 2020. 80p. (in Russian)].
  6. Ghaem-Maghami S., Sagi S., Majeed G., Soutter W.P. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a metaanalysis. Lancet Oncol. 2007; 8(11): 985-93. https://dx.doi.org/10.1016/S1470-2045(07)70283-8.
  7. Heymans J., Benoy I.H., Poppe W., Depuydt C.E. Type-specific HPV genotyping improves detection of recurrent high-grade cervical neoplasia after conisation. Int. J. Cancer. 2011; 129(4): 903-9. https://dx.doi.org/10.1002/ijc.25745.
  8. Bruno M.T., Cassaro N., Garofalo S., Boemi S. HPV16 persistent infection and recurrent disease after LEEP. Virol. J. 2019; 16(1):148. https://dx.doi. org/10.1186/s12985-019-1252-3.
  9. Fan A, Wang C., Han C., Wang Y., Xue F., Zhang L. Factors affecting residual/recurrent cervical intraepithelial neoplasia after cervical conization with negative margins. J. Med. Virol. 2018; 90(9):1541-8. https://dx.doi.org/10.1002/ jmv.25208.
  10. Kreimer AR., Rolando H., Sampson J.N., Porras C., Lowy D.R., Schiller J. T. et al.; Costa Rica HPV Vaccine Trial (CVT) Group. Evidence for single-dose protection by the bivalent HPV vaccine - Review of the Costa Rica HPV vaccine trial and future research studies. Vaccine. 2018; 36(32, Pt A): 4774-82. https:// dx.doi.org/10.1016/j.vaccine.2017.12.078.
  11. Swift B.E., Wang L., Jembere N., Kupets R. Risk of recurrence after treatment for cervical intraepithelial neoplasia 3 and adenocarcinoma in situ of the cervix: recurrence of CIN 3 and AIS of cervix. J. Low. Genit. Tract Dis. 2020; 24(3): 252-8. https://dx.doi.org/10.1097/ LGT.0000000000000542.
  12. Fernandez-Montol M.E., Tous S., Medina G., Castellarnau M., Garcia-Tejedor A., de Sanjos S. Long-term predictors of residual or recurrent cervical intraepithelial neoplasia 2-3 after treatment with a large loop excision of the transformation zone: a retrospective study. BJOG. 2020; 127(3): 377-87. https://dx.doi.org/ 10.1111/1471-0528.15996.
  13. Байрамова Г.Р., Баранов И.И., Ежова Л.С., Трофимов Д.Ю., Припутневич Т.В., Амирханян А. С., Старинская А.М. Плоскоклеточные интраэпителиальные поражения шейки матки: возможности ранней диагностики и тактики ведения. Доктор.Ру. 2019; 11: 61-7. [Bayramova G.R., Baranov I.I., Ezhova L.S., Trofimov D.Yu., Pryputnevich T.V., Amirkhanyan A.S., Starinskaya A.M. Squamous intraepithelial lesions of the cervix: the possibility of early diagnosis and management tactics. Doctor.Ru. 2019; 11: 61-7. (in Russian)].
  14. Адамян Л.В., Серов В.Н., Сухих Г.Т., О.С. Филиппов О.С., ред. Клинические рекомендации. Акушерство и гинекология. Проблемы репродукции. 2017; 23(6, Спецвыпуск). [Adamyan L.V., Serov V.N., Sukhikh G.T., Filippov O.S., ed. Clinical guidelines. Obstetrics and Gynecology. Problems of reproduction. 2017; 23 (6, Special Issue). (in Russian)].
  15. Прилепская В.Н., ред. Заболевания шейки матки и генитальные инфекции. М.: ГЭОТАР-Медиа; 2016. 384с. [Diseases of the cervix and genital infections. Ed.: V.N. Prilepskaya. M.: GEOTAR-Media; 2016. 384p. (in Russian)].
  16. Боровкова Е.И., Федотова А. С. Влияние препаратов для локального применения, содержащих глюкокортикоиды, на показатели местного иммунитета и активность вируса папилломы человека. Гинекология. 2017; 19(2): 66-8. [Borovkova E.I., Fedotova A.S. Influence of preparations for local use containing glucocorticoids on indices of local immunity and activity of the human papillomavirus. To help the practicing physician. Gynecology. 2017; 19 (2): 66-8. (in Russian)].
  17. Кocтавa М.Н. Роль воспаления в диагностике и лечении патологии шейки матки. Москва, Научный центр акушерства, гинекологии и перинатологии РАМН, 1 ноября 2003. Доступно на: https://medi.ru/info/11799/
  18. Дубоссарская Ю.А., Дубоссарская З.М. Тержинан - препарат выбора при лечении бактериального вагиноза. Здоровье женщины. 2012; 6: 147-152. [Dubossarskaya Yu.A., Dubossarskaya Z.M. Terzhinan is the drug of choice in the treatment of bacterial vaginosis. Woman's health. 2012; 6: 147-152. (in Russian)].
  19. Амирханян А.С., Байрамова Г.Р., Киселев В.И., Прилепская В.Н., Полозников А.А., Бурменская О.В., Бабкина И.О., Асатурова А.В. Хронический цервицит, ассоциированный с вирусом папилломы человека и маркеры воспаления у женщин репродуктивного возраста. Акушерство и гинекология. 2019; 4: 49-57. [Amirkhanyan A.S., Bayramova G.R., Kiselev V.I., Prilepskaya V.N., Poloznikov A.A., Burmenskaya O.V., Babkina I.O., Asaturova A.V. Chronic cervicitis associated with human papillomavirus and markers of inflammation in women of reproductive age. Obstetrics and Gynecology. 2019; 4: 49-57. (in Russian)]. https://dx.doi. org/10.18565/aig.2019.4.49-57
  20. Прилепская В.Н., Уруймагова А.Т., Иванова А.А. Клинические и лабораторные особенности рецидивирующих вульвовагинитов и вагинозов. Возможности эффективной терапии. Гинекология. 2020; 22(5): 76-80. [Prilepskaya V.N., Uruimagova A.T., Ivanova A.A. Clinical and laboratory features of recurrent vulvovaginitis and vaginosis. Possibilities of effective therapy. Gynecology. 2020; 22(5): 76-80. (in Russian)].
  21. Зароченцева Н.В., Трушина О.И., Новикова Е.Г., Баранов И.И., Лопухов П.Д., Ровинская О.В. Вакцинация против ВПЧ: теоретические аспекты и практические результаты профилактики рака шейки матки. Эпидемиология и вакцинопрофилактика. 2019; 18(6): 98-108
  22. ВОЗ. Вакцины против папилломавирусной инфекции человека: документ по позиции ВОЗ, октябрь 2014. Еженедельный эпидемиологический бюллетень. 2014; 43(89): 465-92
  23. Velentzis L.S., Brotherton J.M.L., Canfell K. Recurrent disease after treatment for cervical pre-cancer: determining whether prophylactic HPV vaccination could play a role in prevention of secondary lesions. Climacteric. 2019; 22(6): 596-602. 1 https://dx.doi.org/0.1080/13697137.2019.1600500.
  24. Hildesheim A., HerreroR., WacholderS., RodriguezA.C., Solomon D., Bratti M.C. et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA. 2007; 298(7): 743-53. https://dx.doi.org/10.1001/jama.298.7.743.
  25. Hildesheim A., Gonzalez P., Kreimer A.R., Wacholder S., Schussler J., Rodriguez A.C. et al. Impact of human papillomavirus (HPV) 16 and 18 vaccination on prevalent infections and rates of cervical lesions after excisional treatment. Am. J. Obstet. Gynecol. 2016; 215(2): 212. e1-212. e5. https://dx.doi. org/10.1016/j.ajog.2016.02.021.
  26. Joura E.A., Garland S.M., Paavonen J., Ferris D.G., Perez G., Ault K.A. et al. Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. 2012; 344: e1401. https://dx.doi.org/10.1136/bmj.e1401.
  27. Garland S.M., Paavonen J., Jaisamrarn U., Naud P., Salmeron J., Chow S.N. et al. Prior human papillomavirus-16/18 AS04-adjuvanted vaccination prevents recurrent high grade cervical intraepithelial neoplasia after definitive surgical therapy: post-hoc analysis from a randomized controlled trial. Int. J. Cancer. 2016; 139(12): 2812-26. https://dx.doi.org/10.1002/ijc.30391.
  28. Lichter K., Krause D., Xu J., Tsai S.H.L., Hage C., Weston E. et al. Adjuvant Human Papillomavirus Vaccine to Reduce Recurrent Cervical Dysplasia in Unvaccinated Women. A Systematic Review and Meta-analysis: Correction. Obstet Gynecol. 2020; 135(6): 1489. https://dx.doi.org/10.1097/ AOG.0000000000003937.
  29. Hildesheim A., Wacholder S., Catteau G., Struyf F., Du bin G., Herrero R.; CVT Group. Efficacy of the HPV-16/18 vaccine: final according protocol results from the blinded phase of the randomized Costa Rica HPV-16/18 vaccine trial. Vaccine. 2014; 32(39): 5087-97. https://dx.doi.org/10.1016/ j.vaccine.2014.06.038.
  30. Haupt R.M., Wheeler C.M., Brown D.R., Garland S.M., Ferris D.G. et al. Impact of an HPV6/11/16/18 L1 virus-like particle vaccine on progression to cervical intraepithelial neoplasia in seropositive women with HPV16/18 infection. Int. J. Cancer. 2011; 129(11): 2632-42. https://dx.doi.org/10.1002/ ijc.25940.
  31. Herweijer E., Sundstrom K., Ploner A., Uhnoo I., Sparen P., Arnheim-Dahlstrom L. Quadrivalent HPV vaccine effectiveness against high-grade cervical lesions by age at vaccination: A populationbased study. Int. J. Cancer. 2016; 138(12): 286774. https://dx.doi.org/10.1002/ijc.30035.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies