Predição de doença residual após procedimento excisional: uma comparação entre curetagem de canal endocervical e as margens da peça cirúrgica de excisão da zona de transformação

Abstract

The Human Papillomavirus (HPV) is responsible for the most prevalent sexually transmitted infection (STI) among the sexually active population worldwide. Its persistence in the uterine cervix can lead to precursor lesions of cervical cancer, known as cervical intraepithelial lesions, which have effective and safe treatment. High-grade lesions should be treated by excision of the transformation zone (ETZ), which involves removing the portion of the cervix most affected by the viral transformation process. After treatment, it is essential to adopt measures capable of identifying the persistence or recurrence of neoplastic lesions in the remaining cervical stump. The primary evaluation currently involves assessing the surgical margin involvement in the specimen removed during ETZ. Even in the absence of such involvement, approximately onethird of patients may still present residual disease. In this context, endocervical curettage (ECC) in the excisional bed after ETZ is significant for complementary evaluation of margin status. Therefore, the study aimed to investigate the prevalence of residual endocervical lesions in the cervical stump identified through surgical margin involvement and the ECC proposed in this study, as well as to evaluate the agreement between the diagnoses. The study was conducted as a census, including all patients from the Lower Genital Tract Pathology and Colposcopy (PTGIC) outpatient clinic at the University Hospital of UFJF/EBSERH, admitted between 2022 and 2024, who underwent ETZ via high-frequency surgery (LEEP) or cold knife conization for complementary diagnosis or treatment of cervical lesions. Sociodemographic characteristics and gynecological-obstetric history were compared with results suggestive of residual disease by both methods. The dependent variable, the result of the anatomical-pathological analysis of ECC, was compared with the independent variable, the result of the anatomical-pathological analysis of the surgical margins from ETZ. The association between diagnostic methods was analyzed using the Kappa test. Variables were associated through bivariate analyses with a 95% confidence interval. A total of 120 patients participated in the study, with a mean age of 40 years, predominantly white, and mostly diagnosed with high-grade cervical intraepithelial lesions. The study detected surgical margin involvement in 27.9% of cases and endocervical curettage involvement in 10% of cases. Four patients tested positive in the curettage analysis and negative in the margin evaluation, indicating possible false negatives for the method currently used as the standard. The sensitivity of ECC in the excisional bed was 0.21, and its specificity was 0.95. Negative and positive predictive values of the proposed method were 0.76 and 0.60, respectively. According to the Kappa method, agreement between diagnostic methods was weak (Kappa 0.197). Among sociodemographic and gynecological-obstetric characteristics, only skin color was associated with surgical margin positivity, with a p-value of 0.046. It was concluded that endocervical curettage in the excisional bed after excision of the transformation zone can complementarily contribute to the analysis of surgical margin involvement in patients undergoing excisional procedures for the treatment and diagnosis of cervical intraepithelial lesions.