ĐÁNH GIÁ LỰA CHỌN VÀ HIỆU QUẢ CÁC PHƯƠNG PHÁP ĐIỀU TRỊ TRONG TỔN THƯƠNG TIỀN UNG THƯ CỔ TỬ CUNG

Abstract

Objective: To describe the clinical and paraclinical characteristics and to evaluate treatment modalities in patients with CIN II, CIN III, and CIS. Methods: A retrospective descriptive study was conducted on 290 patients with CIN II, CIN III, and CIS treated with LEEP or cold-knife conization (CKC) at the National Hospital of Obstetrics and Gynecology from January 2022 to December 2024. Results: A total of 290 patients were included. The choice of treatment modality was associated with age, parity, HPV infection status, and, in particular, the severity of histopathological lesions. Patients aged ≥40 years were mainly treated with LEEP (85.1%; p < 0.001), and nulliparous women were also predominantly treated with LEEP (87.3%; p = 0.009). HPV DNA results showed that the HPV16-positive group had a higher rate of CKC (p = 0.019). However, multivariable regression confirmed that pre-intervention histopathology was the strongest determinant: patients with CIN III/CIS had a substantially higher likelihood of being assigned to CKC compared with those with CIN II (OR = 0.01; 95% CI: 0.004-0.023; p < 0.001). CKC yielded deeper and wider specimens (1.59 cm vs. 1.06 cm; p < 0.001), helping to achieve safer surgical margins in CIN III+ lesions. Conclusion: The selection of treatment for CIN depends primarily on biopsy-confirmed lesion severity. LEEP is appropriate for CIN II and young nulliparous women due to its simplicity, minimal invasiveness, and preservation of fertility. CKC is a safer option for CIN III/CIS because it provides larger and deeper specimens, reducing the risk of missed lesions and recurrence. Individualizing indications based on histopathology and obstetric characteristics helps optimize treatment effectiveness while preserving reproductive function.