CIN3 치료에서 자궁경부 원추절제술후 잔류 병변의 예측 인자로 절제면 양상 및 고위험 HPV 검사에 대한 연구

Abstract

OBJECTIVE To identify resection margin status and HPV DNA test as predictive factors for residual lesion in the management of CIN3 with cervical conization.

METHODS A retrospective study was conducted on 96 patients with CIN3 who had been performed cervical conization (LEEP or CKC) between January 1999 and December 2003 at Soonchunhyang university Chunan hospital. Secondary conization or hysterectomy were performed in case of positive margin on cone specimen or negative margin with other hysterectomy indication. Resection margin status and pre conization HPV DNA test were compared with residual lesion on subsequent cone or hysterectomy specimen.

RESULTS Among 96 cases, 24 cases (15.6%) showed positive resection margin on cone specimen. Of 24 cases with positive resection margin, 2 cases were followed up without treatment, 2 cases were treated with secondary conization and 20 cases were treated with hysterectomy. Of 72 cases with negative resection margin, hysterectomy was performed due to other indication in 16 cases. Persistence of residual lesion in the secondary conization and hysterectomy specimens was significantly correlated with high risk HPV infection and positive resection margin status (p<0.05).

CONCLUSION Conization is good treatment modality of the management of CIN3. HPV DNA test and resection margin status are good predictor of residual lesion after cervical conization for the management of CIN 3. Therefore, when HPV positive and resection margin positive, secondary treatment is mandatory.