Recurrence/persistence of cervical intraepithelial neoplasia after undergoing a LEEP conization at Instituto Nacional de Enfermedades Neoplásicas
DOI:
https://doi.org/10.24265/horizmed.2017.v17n1.02Keywords:
Cervical intraepithelial neoplasia, Recurrence, LEEP conizationAbstract
Objective: To determine the incidence of recurrence/persistence of cervical intraepithelial neoplasia (CIN) in patients who underwent a loop electrosurgical excision procedure (LEEP) at the Department of Gynecologic Oncology of Instituto Nacional de Enfermedades Neoplásicas (INEN).
Materials and methods: A retrospective cohort study in which medical records of patients who underwent a LEEP conization from January 2002 to December 2003 were examined. After the LEEP conization, patients were divided into two groups: one with positive margin and another one with negative margin. Follow-up was performed every 3 months and consisted of a physical examination, Pap test and colposcopy. The outcome was recurrence of CIN. To assess the risk of CIN recurrence among the study groups, relative risk (RR) and its respective 95% confidence interval (CI) were calculated.
Results: A total of 451 patients underwent a LEEP conization during the study period. The mean age was 35.32 years old, the mean number of sexual partners was 2.1 and the mean number of children was 2.7. One hundred and nine (109) patients (25%) showed a positive margin and 342 (75%) showed a negative one. Out of these subjects, only 94 and 102, respectively, met the eligibility criteria and were followed. The mean follow-up period was 21.74 months. The incidence of recurrence/persistence in patients with positive margin was 5.5%, while the incidence of recurrence/persistence in the group of patients with negative margin was 1.96%. We found no significant differences in the risk of CIN recurrence in the group of patients with positive margin versus patients with negative margin. RR = 2.7, 95% CI (0.41 to 33.8).
Conclusion: There was no significant difference in the incidence of cervical intraepithelial neoplasia between patients with positive margin and patients with negative margin.
Downloads
References
Anttila A, Kotaniemi-Talonen L, Leinonen M, Hakama M, Laurila P, Tarkkanen J, et al. Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme. BMJ. 2010; 340: 1804.
Reich O, Pickel H, Lahousen M, Tamussino K, Winter R. Cervical intraepithelial neoplasia III: Long-term outcome after cold-knife conization with clear margins. Obstet Gynecol 2001; 97(3):428-30.
Duesing N, Schwarz J, Choschzick M, Jaenicke F, Gieseking F, Issa R. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet.2012;286(6):1549-54.
Casta S, De Unzo M, Infante F, Bonacita B, Marinelli M, Rubino A, et al. Disease persistence in patients with cervical intraepithelial neoplasia undergoing electrosurgical conization. Gynecol oncol. 2002; 85(1):119-24.
Serati M, Siesto G, Carollo S, Formenti G, Riva C, Cromi A, et al. Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study. European Journal of Obstetrics & Gynecology and Reproductive Biology.2012;165:86–90.
Fogle RH, Span CO, Ecoley KA, Basil J. Predictors of cervical dyspasia after the loop electrosurgical excision proceduce. J Reprod Med. 2004; 49(6):481-6.
Baloglu A., Uysal D, Bezircioglu I, Bicer M, Inci A. Residual and recurrent disease rates following LEEP treatment in highgrade cervical intraepithelial lesions. Arch Gynecol Obstet. 2010; 282(1):69–73.
Wu D, Zheng Y, Chen W, Guo C, Yu J, Chen G, et al. Prediction of residual/recurrent disease by HPV Genotype after loop excision procedure for high-grade cervical intraepithelial neoplasia with negative margins. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2011; 51: 114–8.
Melli P, Duarte G, Quintana S. Multivariate analysis of risk factors for the persistence of high-grade squamous intraepithelial lesions following loop electrosurgical excision procedure. International Journal of Gynecology and Obstetrics. 2016; 133: 234–7.
Zhu M, He Y, Baak JP, Zhou X, Qu Y, Sui L, et al. Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study. BMC Cancer. 2015;15:744.
Massad LS, Einstein MH, Huh WK, Katki H, Kinney W, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013;17:S1–S27.
Skimer E, Gehrig P, Van Le L. High grade squamous Intraepithelial Lesions: abbreviating posttreatment surveillance. Obst & Gynecol. 2004; 103(3): 488-92.
Oshea A, Stockdale C. The impact of LEEP margin status on subsequent abnormal cervical cytology. Proceedings in Obstetrics and Gynecology. 2014;4(2):5.
Ramchandani SM, Houck KL, Gaughan JP, Roth A. Predicting Persistent/Recurrent Disease in the Cervix After Excisional Biopsy. Medscape General Medicine. 2007;9(2):24.
Malapati R, Chaparala S, Cejtin HE. Factors influencing persistence or recurrence of cervical intraepithelial neoplasia after loop electrosurgical excision procedure. J Low Genit Tract Dis. 2011;15(3):177-9.
Chikazawa K, Netsu S, Motomatsu S, Konno R. Predictors of recurrent/residual disease after loop electrosurgical excisional procedure. J Obstet Gynaecol Res. 2016; 42(4): 457-63.
Tillmanns T, Falkner C, Engle D, Wan J, Mannel R, Walker J, et al. Preoperative predictors of positive margins after loop electrosurgical excisional procedure-cone. Gynecol Oncol. 2005;100(2):379-84.
Tate D, Anderson R. Recurrence of cervical dysplasia among women who are infected with the human immunodeficiency virus: a case-control analysis. American Journal of Obstetrics and Gynecology.2002; 186(5):880–2.
Soto-Wright V, Samuelson R, McLellan R. Current Management of Low-Grade Squamous Intraepithelial Lesion, High-Grade Squamous Epithelial Lesion, and Atypical Glandular Cell. Obst & Gynecol. 2005; 48(1):147-59.
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Horizonte Médico (Lima)

This work is licensed under a Creative Commons Attribution 4.0 International License.
Horizonte Médico (Lima) (Horiz. Med.) journal’s research outputs are published free of charge and are freely available to download under the open access model, aimed at disseminating works and experiences developed in biomedical and public health areas, both nationally and internationally, and promoting research in the different fields of human medicine. All manuscripts accepted and published in the journal are distributed free of charge under the terms of a Creative Commons license – Attribution 4.0 International (CC BY 4.0).