A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia

Abstract

Objective To examine the long term efficacy of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and to evaluate the relative diagnostic merits of colposcopy and cytology in the follow up of these women.Design A retrospective examination of cytology, colposcopy and histology records of the first 1000 women treated with LLETZ in Aberdeen from 1989 to 199 1.Setting Colposcopy Clinic Aberdeen Royal Infirmary, Grampian Region, Scotland.Results Nine hundred and seventy-seven women (97.7%) were seen for follow up at least once and 3 17 were followed for as long as four years. This comprises 2812 woman years of follow up. The incidence of recurrent CIN was 27/1000 woman years and the cumulative rate of recurrence at four years was 10.1 per 100 women. Twenty-eight of the 59 women (47%) with abnormal colposcopy and proven CIN had a concurrent smear that did not show dyskaryosis.Conclusions LLETZ is an effective form of treatment for CIN. Colposcopy was useful in the follow up of these women and expedited the treatment of persistent disease. We recommend that any follow up protocol should include a colposcopic assessment and cytological follow up for at least four years following treatment. Further data are required to determine the risk of recurrence beyond this time.

Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ)

“…Large loop excision of the transformation zone (LLETZ) has been accepted by the medical community as the mainstay technique for high-grade CIN removal. LLETZ has some advantages over other conservative treatments: it can be performed under local anesthesia and in an office setting, preserve fertility and has similar CIN cure rates when compared to other conservative treatments (Duggan et al, 1999;Eduardo et al, 1996;Flannelly et al, 1997;Paraskevaidis et al, 2001). Nevertheless, patients who underwent LLETZ must be followed closely because 5-30% of them may present CIN recurrences in up to 30 months after the procedure (Holowaty et al, 1999).…”

Evaluation of the Combination of Cytology and Hybrid Capture to Safely Predict the High-Grade Lesion Status of Patients Treated with Conization with Large Loop Excision of the Transformation Zone

“…Treatment of these lesions consists of excision, which is usually performed by conization with large loop excision [6,7]. Some risk factors for the recurrence or persistence of high-grade disease are age, smoking, margin status of the cone, and HPV persistence [7,8,9].…”

“…Some risk factors for the recurrence or persistence of high-grade disease are age, smoking, margin status of the cone, and HPV persistence [7,8,9]. …”

Detección del virus del papiloma humano de alto riesgo por captura híbrida II® según hallazgos citológicos en mujeres tratadas por lesiones escamosas intraepiteliales de cuello uterino, período 2006/2010

“…Moreover, women who have lesion-free surgical margins show a risk of treatment failure of 2-6%, regardless of the treatment used. The cumulative rate of invasion eight years after treatment is 5.8 cases/1,000 women, which is five times higher than that of the general population [8][9][10][11][12][13][14] . In addition to considering the compromised surgical margins as a recurrence factor, there are other factors that promote the persistence or recurrence of squamous intraepithelial lesions (SIL) after treatment, such as age, parity, cytological diagnosis and degree of lesion prior to treatment 15 .…”