Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment

Mahadevan, N.; Horwell, David

doi:10.1111/j.1471-0528.1993.tb14292.x

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…Thus, lesions that enter into the endocervical canal may not be completely visible, leading to a risk of residual lesion; however, we did not identify this factor as a possible cause of lesion persistence. Thus, consistent with previous studies, we verified that lesion persistence does not seem to be related to lesion visibility [15–19].…”

Section: Discussionsupporting

confidence: 93%

Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins

et al. 2019

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Background We aimed to determine demographic and clinicopathological predictors for residual disease in women with cervical intraepithelial neoplasia (CIN 2/3) with endocervical cone margin involvement. Methods and findings A cross-sectional study was conducted. The eligible patients were women who underwent hysterectomy as a treatment option after having a positive endocervical margin for CIN 2/3 in cervix conization specimens from 2000 to 2015. The patients were divided into two groups based on the persistence of CIN 2/3 and absence of CIN 2/3 in hysterectomy specimens. Demographic, clinical and histology information were collected in both groups. A total of 80 patients were eligible for the study; 37 (46.3%) had no persistence of CIN 2/3 and 43 (53.7%) had persistence of CIN 2/3 in the hysterectomy specimens. Demographic, clinical, and cone specimen characteristics, and a visible squamocolumnar junction and type of conization were analyzed as possible risk factors for the presence of residual lesions at hysterectomy, and none of these variables were associated with residual disease. Menopausal status was strongly associated with a high risk of persistent residual disease 81.2% (OR 4.9, CI 1.27–18.9), P = 0.014. In the multivariate analysis, only a menopausal status ( P = 0.04) was associated with a high risk of persistent lesions. Conclusion This analysis found that menopausal status exhibited an important association with persistent residual disease. Menopausal women with endocervical margin involvement exhibit a greater than 80% risk of persistent lesions.

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Section: Discussionsupporting

confidence: 93%

Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins

et al. 2019

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“…As one type of cervical conization surgery, the loop electrosurgical excision procedure (LEEP) has been widely applied with ideal therapeutic effects. However, 2–48 % of patients with HSIL who are treated with LEEP have been reported to have persistent/recurrent disease after an initial LEEP for HSIL [ 1 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study

Zhu

Baak

et al. 2015

BMC Cancer

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BackgroundIn 5–20 % of patients with cervical high-grade squamous intraepithelial lesion (HSIL), a positive margin after the loop electrosurgical excision procedure (LEEP) is associated with persistence/recurrence, but the prognostic value of other clinico-pathological factors is less clear.MethodsAmong 4336 patients with HSIL who underwent an initial LEEP, 275 (6 %) had HSIL-positive margins, 37 of whom were lost to follow-up. We evaluated the remaining 238 patients. Persistence/recurrence was defined as histopathological HSIL during follow-up.ResultsThe age of the patients ranged from 21 to 69 years (median: 40). The median follow-up period was 25 months (range: 6–43). Of the 238 patients, 211 (88.7 %) patients remained free of persistence/recurrence, while 27 (11.3 %) experienced persistence/recurrence. According to a univariate analysis, age (P = 0.03) and maximum specimen diameter (P = 0.043) were associated with persistence/recurrence, but number/location of involved margin sections and the pathology of the endocervical curettage were not (P > 0.10). The relative risk of the subjects (greater than or equal to 35 years ages) was 4.6 times of the subject less than 35 years, the difference was statistically significant (14 % vs. 3 %, P < 0.05). A multivariate analysis indicated that an age of 35 years or older was the only independent risk factor (OR 4.97, 95 % CI 1.14–21.62, P = 0.03).ConclusionIn patients with HSIL and HSIL-involved margins after an initial LEEP, age is a strong independent predictor of persistence/recurrence. Follow-up with screening cytology and/or biopsy may be considered in younger patients, whereas a secondary LEEP/hysterectomy may be considered in older patients.

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“…Some authors suggest that colposcopy does not increase the detection of disease 33 . Other authors 34–36 suggest that an initial follow‐up colposcopy marginally enhances early detection of disease and reduces the false negative rate.…”

Section: Follow‐up After Treatment Of Cinmentioning

confidence: 99%

European guidelines for clinical management of abnormal cervical cytology, Part 2

et al. 2009

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European guidelines for clinical management of abnormal cervical cytology, Part 2The current paper presents the second part of chapter 6 of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening. The first part of the same chapter was published in a previous issue (Cytopathology 2008;19:342-54). This part provides guidance on how to manage and treat women with histologically confirmed cervical intraepithelial neoplasia. The paper describes the characteristics, indications and possible complications of excisional and ablative treatment methods. The three options to monitor the outcome after treatment (repeat cytology, HPV testing and colposcopy) are discussed. Specific recommendations for particular clinical situations are provided: pregnancy, immuno-suppression, HIV infection, post-menopause, adolescence and cyto-colpo-histological disparity. The paper ends with recommendations for quality assurance in patient management and some general advice on how to communicate screening, diagnosis and treatment results to the woman concerned. Finally, a data collection form is attached.

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Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment

Cited by 5 publications

References 3 publications

Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins

Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins

Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study

European guidelines for clinical management of abnormal cervical cytology, Part 2

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