Loop Electrosurgical Excision Procedure or Cervical Conization to Exclude Cervical Cancer Before Simple Hysterectomy

Area of Science:

• Gynecology
• Oncology
• Pathology

Background:

• Abnormal cervical cancer screening tests necessitate further evaluation, often including colposcopy.
• Cervical intraepithelial neoplasia (CIN) and occult cervical cancer require timely diagnosis and management to prevent progression.
• Simple hysterectomy may be performed for various gynecological conditions, but it is crucial to exclude malignancy beforehand.

Purpose of the Study:

• To identify which women require loop electrosurgical excision procedure (LEEP) or cervical conization (cone) after colposcopy to exclude cervical cancer before undergoing simple hysterectomy.
• To assess the diagnostic yield of LEEP or cone in detecting occult cervical cancers in women with abnormal cervical cancer screening tests.

Main Methods:

• A retrospective review of electronic medical records from colposcopy clinics was conducted.
• Chart review of women diagnosed with cervical cancer following colposcopy was performed to identify cases of occult cancer.
• Statistical analysis, including relative risk calculations, was used to evaluate risk factors for occult cervical cancer.

Main Results:

• Of 18,537 colposcopies, 0.6% revealed cervical cancer. Among these, 57 cases of occult cancer were diagnosed via subsequent LEEP or cone.
• The relative risk of occult cervical cancer was significantly higher for women with endocervical curettage (ECC) of CIN 2 or CIN 3 (51.5), cervical biopsy of CIN 3 (34.5), or colposcopic impression of CIN 2+ (8.5).
• Performing LEEP or cone on the 10.9% of colposcopies with high-risk findings (ECC of CIN 2/3, biopsy of CIN 3, or colposcopic impression of CIN 2+) would detect 96.5% of occult cervical cancers before hysterectomy.

Conclusions:

• Women with endocervical curettage (ECC) of cervical intraepithelial neoplasia (CIN) 2 or CIN 3, cervical biopsy of CIN 3, or colposcopic impression of CIN 2+ require LEEP or cone before simple hysterectomy.
• These procedures are essential for excluding cervical cancer and ensuring appropriate management in women with concerning colposcopic findings.
• Timely LEEP or cone can significantly improve the detection rate of occult cervical cancers, preventing unnecessary hysterectomies for malignancy.