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Negative margins and negative HPV tests after large loop excision of the transformation zone: A nationwide historical
Ane-Kersti Skaarup Knudsen1,2,3, Tina Hovgaard Randrup1,2, Ulrik Schiøler Kesmodel3,4
1Department of Obstetrics & Gynecology, Gødstrup Hospital, University Clinic for HPV-Related Gynecological Disease, Herning, Denmark.
Introduction:
Adequate treatment of cervical precancer, defined as negative margins and a negative HPV test post-treatment, is essential for cervical cancer prevention, as inadequate excision of cervical precancer and a positive HPV test are associated with increased risk of recurrence. Here, we aimed to describe trends in the proportion of women receiving adequate treatment in Denmark.
Material And Methods:
Nationwide historical cohort study including Danish women ≥18 years treated with large loop excision of the transformation zone (LLETZ) from 2013 to 2022. Using the Danish Pathology Register, we collected information on all LLETZ procedures performed due to cervical intraepithelial neoplasia grade 1 or worse (CIN1+). We calculated the proportion of negative margins and negative HPV tests post-treatment, overall and stratified by histology, age, calendar time, and residing region. Results were mainly reported descriptively.
Results:
We included 41 128 women (median age: 35 years, interquartile range: 28-44). A total of 20 744 (50.4%) had negative margins, with the lowest proportion in women with CIN3 (47.2%) or adenocarcinoma in situ (38.3%). The proportion of negative margins declined with increasing age, from 54.1% in women aged 18-29 years to 43.6% in women aged ≥50 years. Overall, 62.4% had a negative HPV test, with no major differences observed across histology groups. The proportion of negative HPV tests ranged from 62.8% to 66.9% in women aged 18-49, whereas it was lower in women aged ≥50 years (48.4%).
Conclusions:
Women aged ≥50 years were less likely to have negative margins and a negative HPV test post-treatment compared to women aged 18-49. These findings prompt a need to optimize treatment in this group of women to reduce the risk of cervical cancer.
