Value of top‐hat procedure in management of squamous intraepithelial lesion

Aim To investigate the features of skip lesions and evaluate value of top‐hat procedure in management of squamous intraepithelial lesion. Methods We reviewed the records of patients who underwent loop electrosurgical excision procedure (LEEP) in Peking University First Hospital between 2011 and 2016. Patients were confirmed to have CIN1–3. The term ‘skip lesion’ refers to lesion lying deep in cervical canal discontiguous with other lesions in transformation zone and was confirmed by top‐hat. We compared their lesion grade in patients with or without skip lesion using logistic regression. We further reviewed patients who underwent subsequent hysterectomy within 6 months following LEEP and evaluated if top‐hat procedure led to less residual lesions or was able to predict residual lesions. Results A total of 2260 patients were included and 595 underwent top‐hat procedure. Thirty‐nine out of 595 patients had skip lesions (6.5%), among whom two patients had CIN1 (5.1%), eight had CIN2 (20.5%) and 29 had CIN3 (74.4%). Logistical regression showed CIN3 was associated with higher risk of skip lesions compared to CIN1 (OR = 4.433, 95%CI: 1.036–18.964), while CIN2 was not (OR = 1.762, 95%CI: 0.366–8.471). Sixty‐two patients underwent hysterectomy within 6 months following LEEP (CIN1–3), 24 underwent top‐hat. Analysis revealed top‐hat procedure did not result in less residual lesions. Colposcopy impression or prior HPV test was unable to predict skip lesions. Conclusion About 9.4% patients with CIN3 had skip lesions in the study, which is associated with elevated risk for residual lesion. Top‐hat procedure is able to detect skip lesions, but should not be performed on routinely because its prognostic value is not proved.