Journal of Physiology & Pathology in Korean Medicine (동의생리병리학회지)

The Physiological Society of Korean Medicine and The Society of Pathology in Korean Medicine (대한동의생리학회·한의병리학회)
권호 표지
DOI QR코드

DOI QR Code

4 Cases of Traditional Korean Medicine Treatment for Patients with Surgical Margin Positive after LEEP in Cervical Intraepithelial Neoplasia

LEEP시술 절단면에 병변이 잔존하는 자궁경부상피내종양(CIN) 한의학적 치험 4례

  • Received : 2020.01.20
  • Accepted : 2020.06.24
  • Published : 2020.06.25
Download PDF
⟨ Previous Next ⟩

Abstract

The positive margins after LEEP(loop electrosurgical excision procedure) in cervical intraepithelial neoplasia are generally considered to be a risk factor for the recurrence or persistence of CIN currently. When positive margin exists, secondary LEEP or hysterectomy is performed. The aim of this study was to observe effects of Traditional Korean Medicine treatment for patients with surgical margin positive after LEEP. It was conducted retrospective chart review for 4 patients with the surgical margin positive after LEEP, who were scheduled to have secondary LEEP 3 months later. Patients were treated with herbal medicine, pharmacopuncture and herbal liquid vaginal treatment. They were followed up by cytology, colposcopy, human papillomavirus DNA test and punch-biopsy at 1, 3 and 6 months. After 3 month of treatment, three patients did not need secondary LEEP because of normal cytology, negative HPV status and normal colposcopy, while the other patient underwent secondary LEEP because of ASCUS cytology and positive high-risk HPV. After 6 month of treatment, the other patient also had normal cytology, negative HPV status and normal colposcopy and had been in fifth week of pregnancy. This study suggest that Traditional Korean Medicine treatment may be an effective to the patients with surgical margin positive after LEEP in cervical intraepithelial neoplasia.

Keywords

References

  1. IARC (International agency for reserch on cancer). Cancer incidence in five contient. IARC Sci Publ 2002;155:1-781.
  2. Korea central cancer resistry. Annual report of cancer statistics in Korea in 2016. Monistry of Health and Welfare;2018.
  3. Nasiell K, Roger V, Nasiell M. Behavior of mild cervical dysplasia during long-term follow-up. Obstet Gynecol 1986;67:665-9. https://doi.org/10.1097/00006250-198605000-00012
  4. Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions; a meta analysis. Obstet Gynecol 1998;92:727-35. https://doi.org/10.1016/S0029-7844(98)00245-2
  5. Oster AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 1993;12:186-92. https://doi.org/10.1097/00004347-199304000-00018
  6. Jung DH, Lee KB, Kim KT. Management of gynecologic patients with precancerous disease. Korean J Obstet Gynecolo 2010;53(4):291-302. https://doi.org/10.5468/kjog.2010.53.4.291
  7. Ryu AL, Nam KH, Chung SH, Kim JS, Lee HH, Koh ES, Bae DH. Absence of dysplasia in the excised cervix by a loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia. J Gynecol oncol 2010;21(2):87-92. https://doi.org/10.3802/jgo.2010.21.2.87
  8. Pirtea L, Grigoras D, Matusz P, Pirtea M, Moleriu L, Tudor A, et al. Human papilloma virus persistence after cone excision in women with cervical high grade squamous intraepithelial lesions: a prospective study. Canadian J of infection diseases and medical mocrobiology 2016, Article ID 3076380, 6 pages.
  9. Heo KJ, A Study of External Treatment on the obstetric and gynecologic diseases, Daegu Haany University doctoral dissertation. 2007.
  10. Yoo JE, Lee JY, Yoon YJ. A review on Korean traditional medicine research against cevical dysplasia - focused on studies of cervical cancer and cervical dysplasia. J Korean Obst Gynecol 2013;26(4):191-203. https://doi.org/10.15204/jkobgy.2013.26.4.191
  11. Lee KY, Lee E, Cho NK. Korean medicine treatment for 326 patients with Genital Warts : Retrospective Chart Review. J Korean Med Ophthalmol Otolaryngol Dermatol. 2015;28(4):196-207. https://doi.org/10.6114/jkood.2015.28.4.196
  12. Cho YS, Jung HJ, Jeon SR, Cjo HJ, Son GH, Choi EK. Spontaneous regression of the mild cervical dysplasia and its related factors. Korean J Obstet Gynecolo 2007;50(1):111-116.
  13. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis 2007; 11: 223-39. https://doi.org/10.1097/LGT.0b013e318159408b
  14. Baggish MS, Barash F, Noel Y, Brooks M, Comparison of thermal injury zones in loop elctrical and laser cervical excisional conization. Am J Obstet Gynecol 1992;166:545-8. https://doi.org/10.1016/0002-9378(92)91668-z
  15. Choi IJ, Kwak BG, Cha MS. Effication of loop conization with right-angled triangular shaped excisor in patients with cervical intraepithelial neoplasia 3. J of Gynecolgic oncology 2006;17(3):222-6.
  16. Bollen LJ, Tjong-A-Hung SP, Velden J, Mol BW, Kate FW, et al. Prediction of recurrent and residual cervical dysplasia by human papillomavirus detection among patients with abnormal cytology. Gynecologic Oncology 1999;72(2):199-201. https://doi.org/10.1006/gyno.1998.5250
  17. Lee ES, Jeong DH, Kim JH, Jand DY, Jeoung CH. Analysis of residual tumor based on pathologic severity and site of positive margin after cold-knife conization of the uterine cervix. Korean J Obstet Gynecolo 2008;51(11):1295-1301.
  18. Kim GY, Kim SN, Lee SJ, Gwan HS, Lee GY, Son YS. Human papillomavirus test for prediction of recurrent and residual disease after treatment for cervical intraepithelial neoplasia. Korean J Obstet Gynecolo 2009;52(10):1007-13.
  19. Sun HG, Yoon YS, Jeong NH, Kim T, Kim HJ, et al. Significance of HPV viral load for prediction of recurrence after treatment in patients with carcinoma in situ of cervix. J of Gynecolgic oncology 2007;187(3):187-94.
  20. Houffin DV, Collinet P, Vitatier D, Ego A, Dewilde A, Boman F, et al. Value of human papillomavirus testing after conization by loop electrosurgical excision after high grade squamous intraepithelial lesions. Gynecol Oncol 2003;90:587-92. https://doi.org/10.1016/S0090-8258(03)00372-X
  21. Munoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, et al. Epidermiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003;348(6):518-27. https://doi.org/10.1056/NEJMoa021641
  22. Mark S, Nicolas W. Human papillomavirus(HPV) infection and the multi-stage carcinogenesis of cervocal cancer. Cancer Epidemiol biomarkers prev. 2013;22(4):553-60. https://doi.org/10.1158/1055-9965.EPI-12-1406
  23. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M,Wilkinson EJ, Solomon D. 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis 2007; 11: 223-39. https://doi.org/10.1097/LGT.0b013e318159408b
  24. Chun YG, Hong SR, Kim HS, Kim JY, Kim HS. Histologic correlation of atypical glandular cells in cervical smears. Korean J of pathol 2009;43:453-7. https://doi.org/10.4132/KoreanJPathol.2009.43.5.453
  25. Yu L, Fei L, Liu X, PiX, Wang L, Chen S. Application of p16/Ki-67 dual-staining cytology in cervical cancers. J Cancer. 2019;10(12):2654-60. https://doi.org/10.7150/jca.32743
  26. Jansen FW, Trimbos JB, Hermans J, Fleuren GJ. Persistent cervical intraepithelial neoplasia after incomplete conization: Predictive value of clinical and histological parameter. Gynecol Obstet invest 1994;37:207-4.
  27. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 1998;338:423-8. https://doi.org/10.1056/NEJM199802123380703
  28. Cornelia L, Steven P, Patti G, Brigitte R, Ellen P, Andrea E, et al. Spontaneous Regression of High-Grade Cervical Dysplasia: Effects of Human Papillomavirus Type and HLA Phenotype. Clin Cancer Res. 2005 July 1;11(13):4717-23. https://doi.org/10.1158/1078-0432.CCR-04-2599
  29. Li HM. zhong yao zhui qie zhi liao gong jing fei dian xing xing zeng sheng 96 li lin chuang guan cha(中藥錐切治療官頸非典型性增生96例臨床觀察). Chinese Medicine of Factory and Mine 2005;18(1):67-8. https://doi.org/10.3969/j.issn.1674-8182.2005.01.057
  30. Evy G, Joris F, Hans V, Rita V, Philippe D, Marleen T, et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia: systematic review and meta-analysis. PLoS One. 2012;7(10):e45201. https://doi.org/10.1371/journal.pone.0045201
  31. Bocaardo E, Lepique AP, Villa LL. The role of inflammation in HPV carcinogenesis. Carsinogenesis. 2010;31(11):1905-12. https://doi.org/10.1093/carcin/bgq176