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[Loop electrosurgical excision procedure: a valuable method for the treatment of cervical intraepithelial neoplasia]
1Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Objective:
To determine the effectiveness and safety of loop electrosurgical excision procedure (LEEP) for the management of cervical intraepithelial neoplasia (CIN) and the significance of positive margins in cervical cone biopsy specimens with the relationship of prognosis.
Methods:
LEEP under local anesthesia and colposcopic guidance was performed in an outpatient of colposcopic clinic. Records of 135 patients treated between Feb 1992 and Jul 1999 were reviewed prospectively.
Results:
The median age of patients in this study was 42 years (range 18-67 years), parity 2.2 times (range 0-8 times). High-grade squamous intraepithelial lesion (HGSIL) accounted for majority of diagnosis according to pap smear (65.9%) and colposcopy (75.6%) respectively. The results of LEEP demonstrated negative histology in 7 patients (5.2%), human papilloma virus (HPV) infection in 2 patients (1.5%), CINI in 15 patients (11.1%), HGSIL in 108 patients (80.0%) which including 20 patients (14.8%) of CINII, 88 patients (65.2%) of CINIII, microinvasion in 3 patients (2.2%). Clear resection margin of lesion in cervix was noted in 78 (57.8%) patients. Unclear margins were appeared in 57 (42.2%) patients including 21 cases (15.6%) of resection margin positive and 36 cases(26.7%) of resection margin undetermined. HGSIL accounted for the majority (54 cases, 94.7%) in this kind of patients. The residual CIN occurred in 1 patient (4.8%) with the resection margin positive and 3 patients(8.3%) with the resection margin undetermined respectively. In 2 patients (2.6%) with the resection margin clear. Recurrence CIN occurred in 1 patient (4.8%) with the resection margin positive and 2 patients (5.6%) with the resection margin undetermined respectively, none of the patients (0.0%) with the resection margin clear. The overall cure rate in this study was 93.3% after first LEEP done. The residual CIN was identified in 6 (4.4%) patients. The recurrence CIN occurred in 3 (2.2%) patients. Complications of LEEP occurred in 14.1% (19/135) patients in this study.
Conclusions:
LEEP is a kind of effective and safe method for the treatment of cervical intraepithelial neoplasia. The status of resection margin should be concerned. Margin involvement of specimen is the risk factor for residual and recurrence of CIN.