Predictors of Persistent or Recurrent Disease After Loop Electrosurgical Excision Procedure

Follow-up recommendations after an excisional procedure vary depending on whether or not there is a positive ectocervical or endocervical margin or endocervical curettage (ECC). The purpose of this study was to evaluate the importance of these findings in predicting recurrent/persistent (r/p) disease in a sample of human immunodeficiency virus (HIV)-seropositive and -negative patients.

Loop electrosurgical excision procedures with a concurrent ECC performed at the Cook County ambulatory clinic between September 29, 2008, and April 15, 2014 were included in this study. Chart review was performed to collect demographic data, pathology results, and all subsequent cytology or histology. We examined the association of these factors with r/p disease using χ and Fisher exact tests as well as log-binomial regression.

There were 242 women included for analysis. Of these, 9 LEEP specimens showed invasive cancer or adenocarcinoma in situ, and 15.7% were HIV positive. Mean follow-up was 16.4 months. On bivariate analysis, HIV serostatus, LEEP histology, ectocervical margin, endocervical margin, and ECC were all associated with r/p disease. On multivariate regression, only HIV serostatus and ECC were associated with r/p disease. Among women with either a positive endocervical or ectocervical margin or ECC, the prevalence of r/p disease is 29% if they are HIV negative, and 75% if they are positive.

In our study, ECC seems more predictive of r/p disease than margin status. Most HIV-positive women with positive margins or ECC have r/p disease, whereas most HIV-negative women do not. One should consider HIV serostatus when deciding whether or not to perform repeat excision.