Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study

Abstract

BackgroundIn 5–20 % of patients with cervical high-grade squamous intraepithelial lesion (HSIL), a positive margin after the loop electrosurgical excision procedure (LEEP) is associated with persistence/recurrence, but the prognostic value of other clinico-pathological factors is less clear.MethodsAmong 4336 patients with HSIL who underwent an initial LEEP, 275 (6 %) had HSIL-positive margins, 37 of whom were lost to follow-up. We evaluated the remaining 238 patients. Persistence/recurrence was defined as histopathological HSIL during follow-up.ResultsThe age of the patients ranged from 21 to 69 years (median: 40). The median follow-up period was 25 months (range: 6–43). Of the 238 patients, 211 (88.7 %) patients remained free of persistence/recurrence, while 27 (11.3 %) experienced persistence/recurrence. According to a univariate analysis, age (P = 0.03) and maximum specimen diameter (P = 0.043) were associated with persistence/recurrence, but number/location of involved margin sections and the pathology of the endocervical curettage were not (P > 0.10). The relative risk of the subjects (greater than or equal to 35 years ages) was 4.6 times of the subject less than 35 years, the difference was statistically significant (14 % vs. 3 %, P < 0.05). A multivariate analysis indicated that an age of 35 years or older was the only independent risk factor (OR 4.97, 95 % CI 1.14–21.62, P = 0.03).ConclusionIn patients with HSIL and HSIL-involved margins after an initial LEEP, age is a strong independent predictor of persistence/recurrence. Follow-up with screening cytology and/or biopsy may be considered in younger patients, whereas a secondary LEEP/hysterectomy may be considered in older patients.

Does the trend toward less deep excisions in LLETZ to minimize obstetric risk lead to less favorable oncological outcomes?

“…This was in contrast to the findings of Zhu et al, 17 The present study showed that 12.5% of the endocervical margin was affected, which is significantly lower than the 24.1% described by Venegas-Rodríguez et al 18 In the present study, the affected endocervical margin was found to be a risk factor for pathological cytology presenting at 6 months post-treatment, which increased the risk by three times compared to the non-affected endocervical margin. This was in contrast to the findings of Zhu et al, 17 The present study showed that 12.5% of the endocervical margin was affected, which is significantly lower than the 24.1% described by Venegas-Rodríguez et al 18 In the present study, the affected endocervical margin was found to be a risk factor for pathological cytology presenting at 6 months post-treatment, which increased the risk by three times compared to the non-affected endocervical margin.…”

“…Zhu et al 17 which showed a recurrence of 11.3%, and higher than Venegas-Rodríguez et al 18 who described a 5.5% persistence rate.…”

Lo molecular no es invisible a los ojos

“…En el presente estudio se encontró un porcentaje de recurrencia/persistencia del 5,55%, estos datos son menores que los reportados por Zhu et al en el 2015 de 11.3% (10) . El tiempo promedio de presentación de la recurrencia/persistencia fue 21.4, contrario a los hallazgos encontrados por Skimer et al quien encontró que el 74% de los pacientes que presentaron recurrencia/persistencia fue dentro de los primeros 6 meses de seguimiento (12) .…”

“…A pesar de la efectividad del LEEP/ LLETZ, la recurrencia de NIC varía del 5 al 64% de los pacientes (4,5) . El 74% de los pacientes con NIC 2-3 tratados, presentan recurrencia en los primeros 6 meses (6,7) Múltiples estudios reportan persistencia o recurrencia de NIC en mujeres con márgenes comprometidos por la enfermedad (8)(9)(10) . La habilidad para interpretar los márgenes de escisión es un componente crítico para determinar el manejo óptimo de pacientes tratados por esta patología y se ha mostrado que aproximadamente 10 al 20% de los especímenes obtenidos por cono LEEP/LLETZ son totalmente imposibles de interpretar, aparentemente consecuencia del daño térmico causado.…”

Long-Term Vitamin D Supplementation and the Effects on Recurrence and Metabolic Status of Cervical Intraepithelial Neoplasia Grade 2 or 3: A Randomized, Double-Blind, Placebo-Controlled Trial

“…Recurrence was defined as histology of CIN 1 or higher, which was diagnosed from a biopsy or a subsequent surgical (including LEEP) specimen at any time after the initial LEEP was conducted [14]. CIN 1 corresponded to mild dysplasia, CIN 2 to moderate dysplasia, and CIN 3 corresponded to both severe dysplasia and carcinoma in situ.…”