La maggior parte delle diagnosi istologiche nei referti dell’intervento di
conizzazione riportano la presenza di una HSIL, cioè di una displasia moderata-severa, con margini indenni da trasformazione. Questo dato è a nostro parere molto importante: la metodica LEEP si conferma anche nella nostra popolazione un intervento radicalmente curativo delle lesioni precancerose della cervice uterina, rappresentando quindi un presidio fondamentale per la diagnosi e la terapia precoce di queste lesioni.
Le donne che vanno incontro a conizzazione sono comprese in una fascia di età molto delicata: la maggior parte ha tra i 25 e i 35 anni, età in cui la donna può desiderare una gravidanza.
I cambiamenti nelle linee guida che definiscono lo screening con Pap test e le linee guida colposcopiche si concentrano sull’evitamento di trattamenti inutili in donne con anomalie cervicali, riconoscendo l’alto tasso di regressioni spontanee della displasia di basso grado nelle giovani donne, le complicazioni immediate, e le potenziali conseguenze ostetriche a lungo termine [62].
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Occorre però considerare che l’età a cui le donne hanno una gravidanza è
in aumento: rimandare un intervento che ha scopo curativo potrebbe essere rischioso senza portare benefici.
I risultati della nostra tesi sono significativi all’interno di questa
problematica generale. La valutazione degli outcome ostetrici negativi si pone al centro delle considerazioni necessarie per valutare i criteri di somministrazione dell’intervento di conizzazione.
Il nostro studio da una parte conferma la presenza e la significatività di un certo numero di outcome negativi; dall’altra, per le ridotte dimensioni del
campione e per le difficoltà nel reperire informazioni relative alle dimensioni del cono, non è in grado di dare risultati più precisi sulla relazione tra gli outcome negativi e le modalità con cui l’intervento di
LEEP dovrebbe essere condotto.
Il nostro studio suggerisce che la LEEP dovrebbe essere un intervento riservato ai soli casi di evidente riscontro bioptico di HSIL: in caso di LSIL si potrebbe pensare di proporre un atteggiamento più attendista con controlli ravvicinati nel tempo al fine di procrastinare la conizzazione a un’età successiva.
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9
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