Objective To determine the risk of recurrent cervical intraepithelial neoplasia (CIN) in women with complete or incomplete excision of cervical intraepithelial neoplasia treated by large loop excision of transformation zone (LLETZ). Design A retrospective studySetting One consultant-led colposcopy clinic at Leicester Royal InfirmaryPopulation Three hundred and ninety-four women referred consecutively to the colposcopy clinic between 1991 and 1992. Main outcome measuresThe histological recurrence rate of CIN, length of cytological follow up following treatment related to degree of completeness of excision at initial treatment.Results Three hundred and twenty-two women had complete cytological or histological follow up. The mean length of follow up was 73 months with a mean number of six smears. Women with incomplete excision of CIN had a significantly higher risk of recurrent CIN (relative risk 8.23) occurring in a significantly shorter time compared with women with complete excision.This study demonstrates that large loop excision of transformation zone is successful in over 95% of cases. Cytological surveillance is satisfactory for follow up of women who have complete excision of CIN. Women with incomplete excision of CIN at initial LLETZ remain at significant risk of developing further CIN and long term colposcopic and cytological follow up is necessary. Conclusions

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Summary. The colposcopic and cytological findings at follow‐up of 1000 women treated by laser ablation for cervical intraepithelial neoplasia or human papillomavirus infection at the Regional Department of Gynaecological Oncology, Gateshead, were reviewed. Colposcopy detected six of 27 patients with residual disease compared with cytology which was abnormal in 26 of the 27 and detected 21 as abnormal on the first visit after laser treatment. In our unit invasive disease after laser treatment was never detected solely on initial colposcopic review.

Summary. Thirty‐two patients presenting with abnormal vaginal cytology following hysterectomy were studied. Seven (21·8%) had had hysterectomy for benign conditions whilst 25 (78·1%) had cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma. Twenty‐five patients had partial or total vaginectomy (15 as the primary procedure), and one required laser treatment following vaginectomy. Of 11 (34·3%) patients treated primarily by laser, five subsequently required vaginectomy because of persistent or recurrent cytological abnormality. All four patients treated with topical 5‐fluorouracil or dinitrochlorobenzene subsequently required surgery. Nine of the 32 patients (28·1%) proved to have invasive carcinoma of the vagina on histological examination of the vaginectomy specimen. At the time of writing all patients in the study are well with no evidence of disease.

This study was to determine the risk of finding significant cervical pathological abnormality in women referred to the colposcopy clinic primarily because of postcoital bleeding. We evaluated the cervical smear history of such women and correlated this with any colposcopic or pathological abnormality. There were 142 women seen over a period of 12 months. The age range of the study population was 16 - 61 years (mean age of 34.1 years). There was no case of lower genital tract invasive neoplasia. Out of the 142 cases, 56 women (39.4%) had normal findings at colposcopy and 44 (31%) were secondary to cervical ectopy. A total of 27 (19%) had cervical intraepithelial neoplasia (CIN) out of which there were 15 (10.6%) cases of high-grade disease (CIN II and CIN III); and, 20 (74%) out of the 27 women with CIN had a recently negative cervical smear (within the previous 36 months). Seven women (4.9%) had benign cervical polyps that were removed during colposcopy. The frequency of finding invasive lower genital tract neoplasia in women with postcoital bleeding is low. However, a good proportion of them would have a diagnosis of cervical intraepithelial neoplasia even with a recently negative cervical smear. Therefore, postcoital bleeding should remain an indication for referral to the colposcopy clinic for a detailed evaluation of the lower genital tract.