Hysterectomy through Minimally Invasive Surgery for Cervical High-grade Intraepithelial Neoplasia: Reassessment of the Specimens' Eligibility for Histological Examination

Shuichi Kurihara; Yoichiro Hamasaki; Sachiko Onjo; Kenichi Nishiyama; Makoto Nishida

doi:10.4103/gmit.gmit_68_22

Hysterectomy through Minimally Invasive Surgery for Cervical High-grade Intraepithelial Neoplasia: Reassessment of the Specimens' Eligibility for Histological Examination

Gynecol Minim Invasive Ther. 2023 Aug 10;12(3):148-152. doi: 10.4103/gmit.gmit_68_22. eCollection 2023 Jul-Sep.

Authors

Shuichi Kurihara^{1

2}, Yoichiro Hamasaki¹, Sachiko Onjo¹, Kenichi Nishiyama³, Makoto Nishida¹

Affiliations

¹ Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan.
² Department of Obstetrics and Gynecology, Japanese Red Cross Matsuyama Hospital, Matsuyama, Ehime, Japan.
³ Department of Pathology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan.

Abstract

Objectives: The objective was to investigate the microscopic artifacts made in the uterus of cervical high-grade squamous intraepithelial lesion (HSIL) resected by hysterectomy through minimally invasive (H-MI) procedures and to verify whether these specimens are suitable for histopathological assessment.

Materials and methods: This single-center retrospective study analyzed 28 patients with cervical HSIL, consisting of 21 premenopausal and seven postmenopausal women, who underwent H-MI. The proportion of the cervical mucosa covered by intact surface epithelium (residual ratio [RR]) was measured on microscopically. Surgical margin's status was also verified.

Results: All cases developed detachment of the cervical surface epithelium to a varying extent. The RR was significantly higher in the premenopausal patients (median: 75.5%) than in the postmenopausal patients (median: 37.6%). Among the premenopausal patients, the RR was lower in the cases on whom uterine manipulator (UM) was used (median: 70.5%) than in the cases without UM use (median 92.7%). Among the 21 cases whose resected uterus contained HSIL, the vaginal resection margin was not assessable in three (14.2%) of the seven postmenopausal cases due to the artifact.

Conclusion: Although transvaginal manipulation of the uterus causes detachment of the cervical surface epithelium, H-MI for cervical HSIL provides an acceptable specimen for histological assessment in premenopausal patients, even if UM is used. In postmenopausal women, H-MI easily develops artifactual loss of cervical surface epithelium, sometimes providing an unfavorable specimen for microscopic assessment.

Keywords: Artifact; high-grade squamous intraepithelial lesion; hysterectomy; minimally invasive surgery.