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Recurrent High-Grade Squamous Intraepithelial Lesion After Loop Excision Procedure Versus Loop Procedure With Top
Alex A Francoeur, Katelyn B Furey1, Juan Ramirez1
1Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
Journal of Lower Genital Tract Disease
|June 7, 2023
Summary
Single-pass loop electrosurgical excision (LEEP-SP) and loop electrosurgical excision with top hat (LEEP-TH) show similar effectiveness in treating cervical intraepithelial neoplasia. Recurrent high-grade squamous intraepithelial lesion (HSIL) rates were comparable between LEEP-SP and LEEP-TH procedures.
Area of Science:
- Gynecology
- Oncology
- Surgical Procedures
Background:
- Cervical intraepithelial neoplasia (CIN) is a precancerous condition of the cervix.
- Loop electrosurgical excision procedure (LEEP) is a common treatment for CIN.
- Variations in LEEP techniques, such as single-pass (LEEP-SP) and with top hat (LEEP-TH), exist.
Purpose of the Study:
- To compare the efficacy of LEEP-SP versus LEEP-TH in preventing treatment failure.
- Treatment failure is defined as the recurrence of high-grade squamous intraepithelial lesion (HSIL) cytology within two years.
Main Methods:
- A single-institution cohort study analyzed data from a prospectively collected cervical dysplasia database.
- Patients undergoing LEEP-SP or LEEP-TH for biopsy-proven CIN between 2005 and 2019 were included.
- Follow-up included cytology and human papillomavirus (HPV) testing at two years.
Main Results:
- No significant difference in HSIL cytology recurrence rates at 2 years between LEEP-SP (5.2%) and LEEP-TH (6.3%).
- No significant difference in positive margins or depth of excision between the two LEEP techniques.
- Patients undergoing repeat excision were more likely to be older and have had LEEP-TH and initial cytologic HSIL.
Conclusions:
- LEEP-SP and LEEP-TH demonstrate comparable effectiveness in treating cervical HSIL.
- LEEP-TH offers limited additional benefit over LEEP-SP for cervical HSIL treatment.
- The choice of LEEP technique may not significantly impact recurrence rates.
