Current understanding of predictors and methods for preventing recurrent cervical intraepithelial neoplasia after loop electrosurgical excision procedure
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.Prilepskaya V.N., Bairamova G.R., Asaturova A.V., Andreyev A.O., Peremykina A.V., Pronina V.A.
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.
Keywords
cervical intraepithelial neoplasia
human papillomavirus
cervical cancer
recurrent CIN
vaccine prevention
loop electrosurgical excision procedure
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Received 07.12.2020
Accepted 15.12.2020
About the Authors
Vera N. Prilepskaya, Honored Scientist of the Russian Federation, Dr.Med.Sci, professor, Head of the Scientific and Polyclinic Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. Tel.: +7(903)109-72-05. E-mail: vprilepskaya@mail.ru.4 Akademika Oparina str., Moscow, 117997, Russia.
Guldana R. Bairamova, Dr.Med.Sci, Professor of the Department of Obstetrics and Gynecology of the Department of Professional Education, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, Head of clinical work of the Scientific and Polyclinic Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. Tel.: +7(926)660-48-77.
E-mail: bayramova@mail.ru. 4 Akademika Oparina str., Moscow, 117997, Russia.
Aleksandra V. Asaturova, Dr.Med.Sci., Head of the 1st Pathology Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. Tel.: +7(495)438-23-11. E-mail: a_asaturova@oparina4.ru. 4 Akademika Oparina str., Moscow, 117997, Russia.
Alexander O. Andreev, 2-year clinical resident, specialty Obstetrics and Gynecology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. Tel.: +7(903)613-00-26. E-mail: sasha.grash2010@yandex.ru.
4 Akademika Oparina str., Moscow, 117997, Russia.
Anastasiia V. Peremykina, сandidate, specialty Obstetrics and Gynecology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. Tel.: +7(915)449-08-11. E-mail: nodushkina@mail.ru. 4 Akademika Oparina str., Moscow, 117997, Russia.
Veronika A. Pronina, 2-year clinical resident, specialty Obstetrics and Gynecology, V.I. Kulakov National Medical Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of the Russian Federation. Tel.: +7(916)025-86-26. E-mail: Ver22595@yandex.ru.
4 Akademika Oparina str., Moscow, 117997, Russia.
For citation: Prilepskaya V.N., Bairamova G.R., Asaturova A.V., Andreyev A.O., Peremykina A.V., Pronina V.A. Current understanding of predictors and methods for preventing recurrent cervical intraepithelial neoplasia after loop electrosurgical excision procedure.
Akusherstvo i Ginekologiya / Obstetrics and gynecology. 2020; 12: 81-88 (in Russian)
https://dx.doi.org/10.18565/aig.2020.12.81-88