Authors: Gassama O, Lemine AOM, Biaye B, Diallo D, Cisse ML, Coly Niassy Diallo A, Faye Dieme ME, Niass A, Mbodji A, Diouf A, Moreau JC
Objectives: To evaluate the management of patients with high-grade cytological lesions (HSIL) received at the colposcopy and cervico-vaginal pathology unit of the Gynecological and Obstetric Clinic at Aristide Le Dantec Hospital.
Material and Methods: This study was a retrospective, descriptive and analytical one we conducted from January 05, 2009 to January 31, 2017 (96 months) involving 145 cases. We recruited all patients received for colposcopy after a Pap smear suggestive of a high-grade lesion according to the 2001 Bethesda classification. The parameters studied included epidemiological data, colposcopic features, colposcopy biopsy findings, therapeutic aspects. , the
results of the histology of the operative specimen and the follow-up. The analysis was done by the means of SPSS 21.
Results: During the study period, we performed 145 colposcopies for patients with high grade lesions. Postmenopausal women accounted for almost half of the patients (48.3%), followed by women in genital activity (42.1%). The average age at first intercourse was 18 years with extremes of 12 and 32 years. One third of our patients (36.5%) used modern contraception. The patients had more than 4 pregnancies in the majority of the cases (82.8%) with an average of 6 pregnancies with extremes of 0 and 15 pregnancies.
The average parity was 5.8 with extremes of 0 and 12. The majority of women had given birth at least four times (64.9%). In colposcopy, vulvoscopy was normal in all patients, examination without preparation found a red zone in 52.4%, examination after application of acetic acid found a mild acidophilus in 4.8%, intense acidophilus in 44.8% and the junction area was visible in 55.9%. Examination after application of lugol found an iodine-negative zone with fuzzy contours in 57.9% of cases. Colposcopy resulted in Grade I atypical transformation in 6.2% and Grade II atypical transformation in 59.3%. After the biopsy under colposcopy, the histology found a microinvasive and invasive squamous cell carcinoma in 37.9%, a CIN 3 in 21.2%, a CIN 2 in 4.5%, a CIN 1 in 9% and a carcinoma in situ in 3%.
We achieved 13 conizations (18%), 29 hysterectomies (40.3%) and 9 colpohysterectomies associated with a lymphadenectomy (12.6%). The postoperative course was simple in all our patients. After surgical treatment, pathology examination showed CIN3 in 34% of cases, CIN2 in 22% of cases, CIN1 in 11% of cases, squamous cell carcinoma in 17% of cases and was normal in 17% of cases.
Conclusion: High-grade lesions are the fundamental step in the evolution of cervical dysplasias to cervical cancer. The management of these lesions is essential in the prevention of cervical cancer.
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