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1 It is now a widely used procedure for diagnosing and treating cervical intraepithelial neoplasia (CIN). It has the advantage of being a potentially curative outpatient excisional procedure which provides a specimen for histological diagnosis and assessment of the excision margins.The stimulus to carry out this study was an apparent lack of correlation between completeness of excision of CIN in LLETZ biopsies and the follow up results anticipated. A study was therefore carried out to assess the risk of persistent/recurrent CIN following LLETZ according to the histological grade and completeness of the original excision. MethodsWe studied 669 consecutive patients aged between 17 and 75 years who had LLETZ biopsies showing CIN grades 1, 2, or 3 over a two year period. LLETZ with no CIN and microinvasive or invasive carcinomas were excluded from the study. Patients selected for LLETZ included not only those in whom CIN was clearly confined to the ectocervix but also those in whom the CIN extended into the endocervix.The LLETZ biopsies were reported by three pathologists whose practice is to collaborate closely, particularly where diYculties are encountered with grading of CIN or the completeness of excision. Many of the more complicated LLETZ biopsies therefore had a consensus diagnosis GRADE OF CINThe LLETZ biopsies were subdivided according to the highest grade of CIN found in each case. The frequency of persistent/recurrent CIN was analysed for each grade of CIN in the LLETZ by a 2 test for trend. COMPLETENESS OF EXCISION OF CINThe LLETZ biopsies were further categorised according to whether they showed complete, incomplete, or equivocal excision of CIN on histological examination. Equivocal excision was where completeness of excision could not be ascertained or where CIN extended "close" to an excision margin. The frequency of CIN was compared by Fisher's exact test between those patients with complete and incomplete, complete and equivocal, and incomplete and equivocal excision of CIN. The patients had all been followed up with cervical cytology or histology, or both, over 1.5 to 3.5 years. The criterion for positive follow up was a histological diagnosis of CIN in samples such as cervical biopsy, repeat LLETZ, cold knife cone biopsy, and hysterectomy specimens. Follow up was considered negative if histology or cytology, or both, was normal.The frequency of persistent/recurrent CIN was compared between patients with incomplete excision at the endocervical margin and those with incomplete excision at the ectocervical margin. The results were analysed by a 2 test. ResultsFour hundred and fifty two LLETZ biopsies showed complete histological excision of CIN

Royal Inf irmary, Manchester, M13 9WW, UK BACKGROUND: Several studies have shown that testing for high-risk human papillomavirus (HPV) types results in an improved sensitivity for CIN2 þ , compared with cytology, although with a somewhat lower specificity. METHODS: We obtained follow-up results, with at least one smear after participation in the HART study, which compared HPV testing (HC-II) with cytology as a primary screening modality. RESULTS: With a median follow-up of 6 years, 42 additional cases of CIN2 þ were identified; women who were HPV positive at baseline were more likely to develop CIN2 þ than those who were HPV negative (hazard ratio (HR) 17.2; 95% confidence interval (CI) (9.3 -31.6)) and the risk increased with increasing viral load. Compared with HPV-negative women (relative light unit (RLU) o1), the HR (95% CI) was 5.4 (1.6, 18.2) for 1 -10 RLU and 25.5 (13.6, 47.9) for RLU X10. Positive cytology (borderline or worse compared with negative) was also predictive of developing CIN2, although to a lesser extent (HR 8.7; 95% CI (4.5 -17.1)). Only one case of CIN3 and three cases of CIN2 were found in women who showed a positive cytology result but were HPV negative at baseline. CONCLUSION: After 5 years of follow-up, CIN2 þ occurred in 0.23% of women who were HPV negative at baseline compared with 0.48% of women who showed a negative cytology result, indicating a much longer low-risk interval for CIN2 þ after HPV testing.

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