EVALUATION OF RESIDUAL LESIONS FOLLOWING CONSERVATIVE TREATMENT OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA

The purpose of this study was to determine the diagnostic value Pap smear test and colposcopy in Georgian National Screening Center, evaluation of efficiency of the excisional treatment and determining the main risk factors for prediction of residual/recurrent disease in patients with high-grade cervical intraepithelial neoplasia. We retrospectively analyzed 613 patients, who underwent excisional treatment of the cervix (LEEP). Follow-up was performed by Pap smear test, colposcopy and histamorphological examinations. Accuracy of Pap smear test and colposcopy prior to the the excisional treatment revealed Pap: Se 83.4%; Sp 76.4%; PPV 72.6%; NPV76.8%; Colposcopy: Se 83.4%; Sp 69.4%; PPV 69.3%; NPV 80.6%; After the excisional treatment: Pap: Se 82.8%; Sp 92.3%; PPV 61.5%; NPV 97.3%; Colposcopy: Se 62.1%; Sp 80.4%; PPV 32.1%; NPV 93.4%. After LEEP colposcopy is less sensitive than before LEEP. After LEEP sensitivity of the Pap smear test exceeds the sensitivity of the colposcopy. Forty one (18.4%) of 223 patients had residual/recurrent lesion during follow-up. According to univariate analysis the patient's age ≥40 years (p<0.01) OR 3.2 (95% CI 1.3-8.4), transformation zone type III (p<0.01) OR 5.0 (95% CI 2.1-11.5), endocervical gland involvement (p<0.01) OR 6.2 (95% CI 2.7 - 15.1 ), smoking status (p<0.001) OR 7.7 (95% CI 3.336-17.8), major abnormal cytology (p<0.05) OR 2.72 (95% CI 0.963-9.512) were significant risk factors for residual/recurrent disease. However, gravidity, parity, severity of disease and positive margins were not relevant factors for the residual/recurrent disease (P>0.05). Consideration and implementation of these predictive factors in patient surveillance protocol will allow avoiding delayed treatment or overtreatment.