The risk of overtreatment or not treating an occult carcinoma exists in women at risk of residual disease after a LEEP excision for CIN3. Our goal was to discover an efficient method to select patients requiring a second LEEP from those requiring a FU only through an mRNA-detection test. In a population of 686 women undergoing a LEEP excision for CIN 3, we selected 285 women at risk of residual disease and subjected them to a search for E6/E7 mRNA HPV. The women with negative mRNA were subjected to a follow up, while the women with positive mRNA were subjected to a second LEEP. The histological examination of the second cone revealed 120 (85.7%) cases of residual disease in the mRNA-positive women: 40 cases of CIN2, 51 cases of CIN3, 11 cases of squamous microinvasive carcinoma, 7 cases of squamous carcinoma, 9 cases of AIS (adenocarcinoma in situ) and 2 cases of adenocarcinoma. Among the mRNA-negative women undergoing a follow up, there were only five cases of residual disease. During the follow-up period of about 6 years, we witnessed the regression of the residual disease and the elimination of the virus, just as predicted by the negative result of the mRNA test. Testing patients for E6/E7 mRNA allowed us to identify women with residual disease (CIN2+) and treat them appropriately.
对于接受宫颈上皮内瘤变3级环形电切术后存在残留病变风险的女性，存在过度治疗或未治疗隐匿性癌变的风险。本研究旨在通过mRNA检测技术，建立一种有效区分需二次环形电切术与仅需随访患者的筛选方法。在686例因CIN3接受环形电切术的女性队列中，我们筛选出285例存在残留病变风险的患者进行HPV E6/E7 mRNA检测。mRNA阴性者接受定期随访，阳性者则接受二次环形电切术。二次锥切组织病理学检查显示，mRNA阳性组中120例（85.7%）存在残留病变：包括40例CIN2、51例CIN3、11例鳞状细胞微浸润癌、7例鳞状细胞癌、9例原位腺癌及2例腺癌。而在接受随访的mRNA阴性组中，仅发现5例残留病变。在约6年的随访期内，正如mRNA阴性结果所预测，我们观察到残留病变的消退及病毒清除。E6/E7 mRNA检测能有效识别存在残留病变（CIN2+）的患者，并为其提供精准治疗。
肿瘤(癌症)患者之家