The purpose of this study was to evaluate the incidence of AIS and AC in the histological cone of women treated for CIN3. Furthermore, through the study of the specific HR HPV genotypes, we obtained more information on the possible different nature between the single CIN3 lesion and the CIN3 coexisting with the glandular lesion. Methods. A sample of 414 women underwent LEEP for CIN3. The study sample consisted of 370 women with a CIN3 lesion alone and 44 women with a CIN3 lesion coexisting with AIS or adenocarcinoma. We studied the individual HR HPV genotypes and their frequency in the two groups under study. Furthermore, the therapeutic results and follow-ups for the population were studied on the entire study sample. Results. In patients with a single CIN3 lesion, 11 high-risk genotypes were detected; in patients with CIN3 associated with AIS or AC, only 4 different genotypes were detected (16, 18, 45, 33). Overall, the frequency of HPV 18 was significantly higher in CIN3 coexisting with AIS compared to solitary CIN3 lesions, χ2 = 27.73 (p< 0.001), while the frequency of other high-risk genotypes was significantly higher in patients with a single CIN3 than in patients with CIN3 coexisting with AIS. In our study population, mixed lesions (CIN3 coexisting with AIS), unlike their squamous counterparts (single CIN3 lesions), were characterized by skip lesions, which demonstrate more aggressive behavior and a higher rate of viral persistence and recurrence. Conclusion. A relatively high rate (10.7%) of AIS-AC was found in women treated for CIN3. Our study confirms the multifocal biological nature of the CIN3 lesion coexisting with AIS compared to the single CIN3 lesion. All this justifies the different treatments to which CIN3 lesions coexisting with AIS are addressed; in fact, the latter are treated with hysterectomy, while CIN3 is treated with conization alone.
本研究旨在评估接受CIN3治疗的女性组织锥切标本中AIS和AC的发生率。此外，通过分析特定高危型HPV基因型，我们获得了关于单纯CIN3病变与CIN3合并腺体病变之间可能存在不同性质的更多信息。方法：对414例因CIN3接受LEEP手术的女性进行取样研究，其中370例为单纯CIN3病变，44例为CIN3合并AIS或腺癌。我们分析了两组病例中个体高危HPV基因型及其分布频率，并在整个研究样本中评估了治疗结果及随访情况。结果：在单纯CIN3患者中检测到11种高危基因型；在CIN3合并AIS/AC患者中仅检测到4种基因型（16、18、45、33）。总体而言，与单纯CIN3病变相比，CIN3合并AIS病例中HPV18的检出频率显著更高（χ2=27.73，p<0.001），而其他高危基因型在单纯CIN3患者中的检出频率显著高于CIN3合并AIS患者。本研究发现，混合性病变（CIN3合并AIS）相较于单纯鳞状上皮病变（单纯CIN3）具有跳跃性病灶的特征，表现出更强的侵袭性、更高的病毒持续存在率和复发率。结论：在接受CIN3治疗的女性中，AIS-AC的发生率相对较高（10.7%）。本研究证实了CIN3合并AIS病变相较于单纯CIN3病变具有多灶性生物学特性。这为CIN3合并AIS病变需采取不同治疗方案提供了依据：此类病变需行子宫切除术治疗，而单纯CIN3仅需锥切治疗。
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