Comparison of Punch and Loop Biopsy in Patients with High-Grade Squamous Intraepithelial Lesion

Yıl 2023, Cilt: 23 Sayı: 2, 37 - 42, 06.11.2023

Varol Gülseren , Kemal Güngördük

Öz

Objective: It was aimed to compare and evaluate the performance of cervical punch and loop biopsy. Methods: Patients who were found to have high-grade squamous intraepithelial lesion (YDSIL) as a result of Pap smear between 2019-2020, and who underwent colposcopy and biopsy were included in the study. The clinical data and demographic characteristics of the patients were evaluated by retrospective file scanning. Patients who had 56 punch biopsy (PB) and 51 Loop cervical biopsies were included in the study. Results: The mean age of the patients was 35.3 ± 8.2 and 37.6 ± 10.5 in the PB and Loop groups, respectively, and no significant difference was found in the results (P= 0.208). While 21.4% of the patients in the PD group were nulliparous, 21.6% of the patients in the Loop group were nulliparous (P= 0.571). The mean specimen width was 4.9 ± 1.2 mm and 11.0 ± 1.7 mm in the PB and Loop groups, respectively (P< 0.001). It was shown that the specimen depth was shorter in the punch biopsy group (3.9 ± 0.7 for PB, 6.6 ± 1.0 for Loop; P< 0.001). Minimal hemorrhages were found at similar rates in both groups (8.9% for PB, 9.8% for Loop). When patients were questioned about pain during the procedure, no difference was found between the groups (5.8 ± 1.3 for PB, 6.2 ± 1.8 for Loop; P= 0.206). Total tissue score was calculated using 3 parameters. It was analyzed that there was no difference between the groups in terms of tissue adequacy (including epithelium + stroma). Conclusion: Although the specimen depth and width were longer in the Loop group and there was cautery artifact, tissue adequacy, bleeding and pain scores were found to be similar between the PB and Loop groups. The superiority of the two biopsy methods over each other has not been proven

Anahtar Kelimeler

HPV, Cervical Cancer, High grade squamous intraepithelial lesion

Yüksek Dereceli Skuamoz İntraepitelyal Lezyonu Olan Hastalarda Punch ve Loop Biyopsinin Karşılaştırılması

Öz

Amaç: Servikal punch ve loop biyopsinin performansını karşılaştırmak ve değerlendirmek amaçlanmıştır. Yöntem: 2019-2020 yılları arasında Pap smear sonucunda yüksek dereceli skuamoz intraepitelyal lezyon (YDSİL) saptanan ve kolposkopi yapılan ve biyopsi alınan hastalar çalışmaya alınmıştır. Hastaların klinik verileri ve demografik özellikleri retrospektif dosya taraması ile değerlendirilmiştir. Çalışmaya 56 tane punch biyopsi (PB) ile 51 tane Loop ile servikal biyopsi alınan hasta dahil edilmiştir. Bulgular: Hastaların yaş ortalama değerleri PB ve Loop gruplarında sırası ile 35.3 ± 8.2 ve 37.6 ± 10.5 olarak saptandı ve sonuçlarda anlamlı farklılık saptanmadı (P= 0.208). PB grubundaki hastaların %21.4’ü nullipar iken Loop grubunda %21.6 hastanın nullipar olduğu görüldü (P= 0.571). Spesmen genişliği PB ve Loop grubunda ortalama sırası ile 4.9 ± 1.2 mm ve 11.0 ± 1.7 mm olarak saptanmıştır (P< 0.001). Spesmen derinliğinin punch biyopsi alınan grupta daha kısa olduğu gösterildi (PB için 3.9 ± 0.7, Loop için 6.6 ± 1.0; P< 0.001). Minimal kanamalar iki gruptada benzer oranlarda (PB için %8.9, Loop için %9.8) saptandı. Hastalara işlem esnasında ağrı sorgulandığında gruplar arasında farklılık olmadığı tespit edildi (PB için 5.8 ± 1.3, Loop için 6.2 ± 1.8; P= 0.206). Toplam doku puanı 3 parametre kullanılarak hesaplandı. Doku yeterliliği (epitel + stroma içermesi) konusunda gruplar arasında farklılık olmadığı analiz edildi. Sonuç: Loop grubunda spesmen derinliği ve genişliği daha uzun bulunmasına ve koter artefaktının olmasına rağmen PB ve Loop grupları arasında doku yeterliliği, kanama ve ağrı skorları gruplar arasında benzer bulundu. İki biyopsi şeklinin birbirine üstünlüğü kanıtlanamamıştır.

Anahtar Kelimeler

Yüksek Dereceli Skuamoz İntraepitelyal Lezyon, HPV, serviks kanseri

Kaynakça

• 1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBO- CAN 2012 V1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. (http://glo- bocan.iarc.fr). Accessed 16 July 2014.
• 2. Labani S, Asthana S. Age-specific performance of ca- reHPV versus Papanicolaou and visual inspection of cervix with acetic acid testing in a primary cervical cancer screening. J Epidemiol Community Health 2015; 2015:205851.
• 3. Stanley M. Pathology and epidemiology of HPV infec- tion in females. Gynecologic oncology. 2010;117(2 Suppl):S5-10.
• 4. Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H, Hacikamiloglu E, Murtuza K, Keskinkilic B, Sencan I. Initial results of population based cervical cancer screening prog- ram using HPV testing in one million Turkish wo- men. Int J Cancer. 2018 May 1;142(9):1952-1958.
• 5. L. S. Massad, Y. C. Collins, and P. M. Meyer, "Biopsy correlates of abnormal cervical cytology classified using the bethesda system," Gynecologic Oncology, vol. 82, no. 3, pp. 516-522, 2001.
• 6. Arora R, Malik A, Zutshi V, Bachani S. Comparison Of Cervical Biopsy Using Punch Biopsy Forceps Versus Loop Electrode. Int. j. clin. biomed. res. 2018;4(4):6-12.
• 7. Wright TC Jr, Richart RM. Loop excision of the uter- ine cervix. Curr Opin Obstet Gynecol. 1995;7:30- 34.
• 8. Petry KU, Glaubitz M, Maschek H, et al. Electrosur- gical loop excision of the transformation zone in treatment of cervix neoplasia. Geburtshilfe Frauen- heild. 1996;56:513 516
• 9. Wetcho T, Rattanaburi A, Kanjanapradit K. Quality of tissue from punch biopsy forceps vs. round loop electrode in colposcopically directed biopsy: a ran- domized controlled trial. J Gynecol Oncol. 2018 Jul;29(4):e52.
• 10. Erdem B, Aşıcıoğlu O, Turan G, et al. Sitolojisi HGSIL Gelen Olgularda Kolposkopik Biopsi ile Ek- sizyonel İşlem Sonuçlarının Korelasyonu: 10 Yıllık Tersiyer Merkez Deneyimi. Zeynep Kamil Tıp Bül- teni;2019;50(2):15-18
• 11. Srisomboon J, Kietpeerakool C, Suprasert P, Siri- aunkgul S, Khunamornpong S, Prompittayarat W Factors affecting residual lesion in women with cer- vical adenocarcinoma in situ after cone excisional biopsy. Asian Pac J Cancer Prev 2007;8:225-8.
• 12. Sahai A, Bansal V, Singh P. Comparison of Punch Bi- opsy and Loop Biopsy for the Management of Seve- re Cervical Intraepithelial Neoplasia (CIN). J Obstet Gynaecol India. 2022 Aug;72(Suppl 1):248-254.
• 13. Öz M, Korkmaz E, Cetinkaya N, Baş S, Özdal B, Meydanl MM, et al. Comparison of topical lidocaine spray with placebo for pain relief in colposcopic pro- cedures: a randomized, placebo-controlled, double- blind study. J Low Genit Tract Dis 2015;19:212-4.
• 14.Nagar HA, Dobbs SP, McClelland HR, Price JH, McClean G, McCluggage WG. The large loop ex- ci-sion of the transformation zone cut or blend ther-mal artefact study: a randomized controlled trial. International Journal of Gynecological Cancer. 2004;14(6):1108-11.
• 15. Byrom J, Douce G, Jones PW, Tucker H, Millinship J, Dhar K, Redman CW. Should punch biopsies be used when high-grade disease is suspected at initial colposcopic assessment? A prospective study. Int J Gynecol Cancer 2006;16(1):253-6.