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High-Grade Cervical Dysplasia After Negative Loop Electrosurgical Excision Procedure.
Lindsay M Kuroki1, Laura James-Nywening, Ningying Wu
11Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Alvin J. Siteman Cancer Center; and 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine. St. Louis, MO.
A negative loop electrosurgical excision procedure (LEEP) for high-grade squamous intraepithelial lesion (HSIL) does not eliminate the risk of high-grade cervical intraepithelial neoplasia (CIN2+). Continued surveillance is necessary, as the risk of CIN2+ persists regardless of LEEP margin status.
Area of Science:
- Gynecology
- Oncology
- Pathology
Background:
- High-grade squamous intraepithelial lesion (HSIL) cervical cytology often necessitates treatment.
- Loop electrosurgical excision procedure (LEEP) is a common treatment for HSIL.
- Understanding outcomes after a negative LEEP is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) after a negative LEEP.
- To identify predictors of CIN2+ recurrence following a negative LEEP.
- To compare outcomes based on LEEP management strategies.
Main Methods:
- A cohort of 106 women undergoing LEEP for HSIL between 2007-2014 was analyzed.
- Negative LEEP was defined as CIN1 or less.
- Kaplan-Meier and Cox proportional hazards models were used to assess persistence/recurrence and predictors of CIN2+.
Main Results:
- The prevalence of CIN2+ after a negative LEEP was 14%.
- Risk of CIN2+ did not differ significantly between management strategies or LEEP margin status (negative vs. positive).
- Predictors of persistent/recurrent CIN2+ included older age, prior LEEP history, and positive LEEP margins.
Conclusions:
- A negative LEEP result does not warrant less stringent surveillance for CIN2+.
- The risk of CIN2+ after a negative LEEP is comparable to cases where CIN2+ is identified in the LEEP specimen.
- Close follow-up is essential for all patients treated with LEEP for HSIL.
