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Repeat Diagnostic and Therapeutic Procedures After Excisional Procedures for High-Grade Cervical Intraepithelial
Bethany Onyirimba1, Ling Chen, Jennifer Ferris
1Department of Obstetrics and Gynecology and the Department of Medicine, College of Physicians and Surgeons, and the Joseph L. Mailman School of Public Health, Columbia University, the Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian Hospital, and the Joseph L. Mailman School of Public Health, New York, New York; and the Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts.
Loop electrosurgical excision (LEEP) for high-grade cervical intraepithelial neoplasia (CIN) led to more repeat procedures than cold knife conization (CKC). CKC was linked to increased hysterectomy and cervical cancer rates.
Area of Science:
- Gynecology
- Oncology
- Public Health
Background:
- High-grade cervical intraepithelial neoplasia (CIN) requires effective treatment to prevent cervical cancer.
- Cervical excisional procedures, including cold knife conization (CKC) and loop electrosurgical excision (LEEP), are standard treatments for CIN.
- Understanding the long-term outcomes of these procedures is crucial for patient management.
Purpose of the Study:
- To compare the long-term rates of repeat diagnostic and therapeutic procedures after CKC versus LEEP for high-grade CIN.
- To evaluate the incidence of hysterectomy and cervical cancer following these treatments.
Main Methods:
- A retrospective analysis of the MarketScan commercial database (2008-2021) identified patients with high-grade CIN treated with CKC or LEEP.
- Propensity score matching was used to balance patient characteristics between the CKC and LEEP groups.
- Patients were monitored for up to 36 months for repeat diagnostic evaluations, repeat excisions, hysterectomy, and cervical cancer.
Main Results:
- After propensity score matching, LEEP was associated with significantly higher rates of repeat diagnostic evaluations (21.2% vs. 19.7%) and repeat excisions (4.3% vs. 2.8%) compared to CKC.
- CKC treatment was associated with higher rates of hysterectomy (4.9% vs. 4.1%) and a higher incidence of cervical cancer (1.2% vs. 0.7%) within 36 months.
- These differences were statistically significant (P < .05 for all comparisons).
Conclusions:
- Both CKC and LEEP for high-grade CIN require substantial subsequent diagnostic and therapeutic interventions.
- LEEP is associated with a greater need for repeat diagnostic and excisional procedures.
- CKC is associated with an increased risk of hysterectomy and subsequent cervical cancer diagnosis.