Follow up after LLETZ: could schedules be modified according to risk of recurrence?

Flannelly, G; Fawzi, H. W.; Lopes, Alberto; Monaghan, John M.

doi:10.1016/s0306-5456(01)00240-6

Cited by 47 publications

(54 citation statements)

References 16 publications

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“…12,15,16 In this study, the endocervical margin was the most compromised, as was seen by other authors. [17][18][19][20] Analysis on the relationship between age and margin compromising showed a positive association, which has also been supported by other authors. 17,21 This study presented more cases of compromised margins when the lesion grade was higher.…”

Section: Discussionsupporting

confidence: 68%

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

et al. 2012

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CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS:The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.reSUMO CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp

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Section: Discussionsupporting

confidence: 68%

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

et al. 2012

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“…However Johnson et al [27], in agreement with previous studies [28,29], showed that only involvement of the endocervical resection margin can be regarded as predictive of recurrence.…”

Section: Other Parameterssupporting

confidence: 58%

The Value of Partial HPV Genotyping After Conization of Cervical Dysplasias

Friebe

Klapdor

Hillemanns

et al. 2017

Geburtshilfe Frauenheilkd

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Introduction In this retrospective study partial genotyping of human papilloma viruses (HPV) using the Abbott RealTime HighRisk HPV Test (RealTime) was compared with simple HPV detection (Qiagen Hybrid Capture 2 Test; hc2) for recurrence prediction at the first follow-up examination after conization of cervical intraepithelial neoplasia (CIN). Methods 144 women who had undergone conization for CIN between January 2007 and December 2013 were included. HPV status was determined preoperatively and at first follow-up using hc2 in 103 women and RealTime in 41 women. Recurrent or persistent CIN was assumed when CIN2+ was confirmed histologically or on comparable cytology findings. Results Of the 144 women with complete data 12 (8.3%) had a recurrence after conization. HPV persistence at follow-up correlated significantly with recurrence (hc2: p = 0.003; RealTime: p = 0.003) and both sensitivity and specificity were high (hc2 = 100 and 78.4% respectively; RealTime = 75.0 and 83.9%). Whereas isolated HPV testing had a relatively low positive predictive value for recurrence (hc2 16%; RealTime 54.5%), this rose to 80% with HPV 16 detection at follow-up. Conclusion At follow-up after conization of CIN the combination of high risk HPV detection and partial genotyping of HPV 16 constitutes excellent diagnostic criteria for recurrence/persistence of CIN.

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“…Ghaem-Maghami et al recommended that patients with incomplete excision margins need close follow-up for at least 10 years and some patients may benefit from an immediate second treatment [10]. Several other studies suggested to follow-up patients with incomplete excision more intensively by colposcopy and/or cytology, because of an increased risk of subsequent dysplasia [11][12][13][14]. Our study however again illustrates that the far majority of patients with incomplete excision do not develop HSIL, so intensive follow-up will result in a possible benefit for only a very small number of these patients.…”

Section: Discussionmentioning

confidence: 99%

Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ)

Eijsink

Bock

Kuiper

et al. 2009

Gynecologic Oncology

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Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ) Eijsink, J. J. H.; de Bock, G. H.; Kuiper, J. L.; Reesink-Peters, N.; van Hemel, B. M.; Hollema, H.; Nijman, H. W.; Mourits, M. J. E.; van der Zee, A. G. J. Objective. To assess the compliance of HSIL patients to the national Dutch routine follow-up protocol in the first 2 years after LLETZ and to determine if based on the status of excision margins, follow-up intervals could be modified.Methods. A prospective cohort study was performed in patients, referred because of an abnormal Pap smear between 1996 and 2004 and treated for HSIL with LLETZ. The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 months, respectively. Follow-up results were completed by using PALGA, the nationwide network and registry of histo-and cytopathology in the Netherlands. To assess compliance to the follow-up protocol, adequate follow-up was defined as three cervical smears taken after 6 (+/− 3), 12 (+/− 3) and 24 (+/− 3) months, respectively.Results. Compliance to the first 2 years follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second and third follow-up cervical smears, respectively. Patients with involved excision margins had a three times higher overall risk of developing a subsequent HSIL after LLETZ as compared to patients with free excision margins (HR: 3.2, 95% CI = 1.3-7.9, p = 0.01). Risk for diagnosing HSIL during the first 12 months of follow-up for patients with free excision margins was only 1%.Conclusions. Compliance to the Dutch national routine follow-up protocol in HSIL patients after LLETZ is only moderate. For HSIL patients with free excision margins after LLETZ the first cytological follow-up interval can safely be increased to 12 months.

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Follow up after LLETZ: could schedules be modified according to risk of recurrence?

Cited by 47 publications

References 16 publications

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

The Value of Partial HPV Genotyping After Conization of Cervical Dysplasias

Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ)

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