Predictors of recurrent/residual disease after loop electrosurgical excisional procedure

The aim of this study was to identify predictors of recurrent/residual disease for management after loop electrosurgical excisional procedure.

We retrospectively reviewed 178 patients with cervical intraepithelial neoplasia grade 3 and microinvasive squamous cell carcinoma who underwent the loop electrosurgical excisional procedure between April 2011 and March 2014. Endocervical/ectocervical margin status, endocervical curettage (ECC) status, and maximum width of cervical intraepithelial neoplasia were assessed. Patients were followed up for 6-12 months.

Patients with endocervical margin involvement were significantly older and those with ectocervical margin involvement were significantly younger than patients with no margin involvement (P = 0.02 for both comparisons). ECC-positive patients were significantly older than ECC-negative patients (P = 0.049). There was a significant difference in the mean width of the cervical intraepithelial neoplasia between women with ectocervical involvement and those without ecto- or endocervical involvement (10.2 ± 3.1 mm vs 7.3 ± 3.5 mm, P = 0.0002). The odds ratios for possible recurrent/residual disease for endocervical involvement, ectocervical involvement, and ECC-positivity were 2.1 (0.5-8.4), 3.2 (1.3-7.9), and 6.8 (1.4-32.1), respectively. However, while most ECC-positive patients underwent a second surgery, most patients with ectocervical involvement did not need further treatment.

Older age and ECC were significantly associated with endocervical margin involvement; younger age and width of cervical intraepithelial neoplasia were associated with ectocervical margin involvement. Ectocervical margin involvement significantly increased the risk of possible recurrent/residual disease; however, these patients might recover naturally. ECC-positivity significantly increased the risk of recurrent/residual disease.