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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.
Objective:
To compare long-term rates of repeat diagnostic and therapeutic procedures among patients with high-grade cervical intraepithelial neoplasia (CIN) treated with cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP).
Methods:
The MarketScan commercial database was used to identify patients with high-grade CIN treated with either CKC or LEEP from 2008 to 2021. Patients with adenocarcinoma in situ were excluded. Propensity score matching was performed to balance clinical and demographic characteristics between the groups. After propensity score matching, patients were monitored for up to 36 months, and the cumulative rates of repeat diagnostic evaluation (colposcopy, biopsy, endocervical curettage), repeat excision (CKC or LEEP), hysterectomy for dysplasia, and cervical cancer were compared between groups using Gray's test.
Results:
A total of 117,235 patients, including 13,147 (11.2%) who underwent CKC and 104,088 (88.8%) who underwent LEEP, were identified. After propensity score matching, the cumulative incidence of repeat diagnostic evaluation for cervical dysplasia was 19.7% after CKC compared with 21.2% after LEEP ( P =.02). Over the same period, repeat excision (CKC or LEEP) was performed in 2.8% of patients after CKC compared with 4.3% after LEEP ( P <.001); the rates of hysterectomy were 4.9% and 4.1%, respectively ( P =.01). By 36 months, cervical cancer was diagnosed in 1.2% of patients after CKC and 0.7% after LEEP ( P <.001).
Conclusion:
Among patients with high-grade CIN who underwent cervical excisional procedures, the requirement for subsequent diagnostic and therapeutic procedures was substantial. Treatment with LEEP was associated with higher rates of repeat diagnostic and excisional procedures, whereas CKC treatment was associated with higher rates of hysterectomy and cervical cancer.