TYPES OF DYSPLASTIC LESIONS AND COMPLIANCE WITH FOLLOW UP IN NORTHEASTERN ROMANIA – A RETROSPECTIVE STUDY

Abstract

Cervical cancer is a worrisome condition as it correlates with a high mortality rate although being one of the most preventable cancer types. Material and methods: The medical data of all patients subjected to an excisional procedure between 2000 and 2020 were retrospectively analyzed. Thus, data regarding age, obstetric history, types of dysplastic lesions in the history, HPV infection status, colposcopic findings, identified dysplastic lesions, and the number of screening tests performed were analyzed. Data entry and analysis were performed using SPSS software version 20.
Results: The study included 455 patients aged between 19 and 62 years old, mean age of 36 years and a standard deviation of 9.07. The analysis of the initial cytology results revealed that the most frequently identified dysplastic lesion was HSIL (High Grade Squamous Intraepithelial Lesion), closely followed by LSIL (Low-grade squamous intraepithelial lesion). The analysis of HPV DNA test recommendations highlighted the fact that in over 50% of cases this test was not performed. In the cases in which DNA HPV test was performed, strains 16 and 18 were most frequently identified. The colposcopic examination revealed that the lesions located within the transformation zone were the most numerous. Of the described lesions, the acetowhite epithelium was most often identified, either isolated or in combination with punctation, mosaic pattern of vascularization or leukoplakia. Conization and LLETZ (Large Loop Excision of the Transformation Zone) were the two excisional procedures used in 46.4% and 44% of the patients, respectively. Histopathological examination showed: 12.5% of the patients presented high-grade HSIL (CIN3) lesions, 47.5% low-grade CIN 1 lesions, and 7% were diagnosed with carcinoma in situ. In the post-intervention follow-up, a total of 202 patients (44.39%) showed up for the first and only 66 patients (14.5%) returned for the second post-intervention follow-up. Conclusions: The types of dysplastic lesions identified by cytology were found to be in percentages similar to those reported in the literature, with the exception of HSIL diagnosis, which was the most frequently identified. This high rate could explain the increased incidence of cervical cancer in our country. Conization and excision procedures represent a valuable method of conservative treatment, preserving at the same time patient’s fertility and avoiding a radical intervention. Low compliance with follow-up among patients from the northeastern region of Romania and the increasing migration of the groups at high risk made us use these excisional procedures even in the case of low-grade lesions in an attempt to reduce the incidence of this disease.