Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment

Abstract

Objective To quantify and analyse the influence of a histological report of incomplete excision of CIN after LLETZ on frequency of detection of residual CIN. Design Review of a computerised database of sequential women treated by LLETZ. Initial follow‐up was three months post‐treatment. Setting The Colposcopy Clinic, Regional Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK. Subjects 721 women with CIN diagnosed histologically on LLETZ specimens. Results In spite of a first time treatment success rate of 95% at 3 months, only 56% of the women were reported to have complete histological excision of CIN. A report suggesting incomplete excision was more likely with more severe CIN, extensive lesions and involvement of the endocervical canal. Furthermore, 21 % with residual CIN had apparent complete excision of CIN at LLETZ. Conclusions A histological report of incomplete excision of CIN at LLETZ does not equate with residual disease. The high treatment success rate of LLETZ means that a report of incomplete excision should stimulate close colposcopic and cyt‐ologic follow‐up to identify the small number of women with residual CIN after therapy.

Determination of Recurrent/Residual Cin-Ii and Cin-Iii After Leep. Cytology or HPV-Dna?

“…It is concordant wih previously reported results which were as high as 40% (15). Although there are some speculations for margin positivity to increase future recurrent/residual disease, common opinion supports monitorization other than re-excision (16,17).…”

Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome

“…This result is similar to an earlier study from our department, which also showed no increased risk of disease recurrence with involved margins. 16 In our study, the overall mean time to recurrence was 48 months regardless of age. Other studies have shown, however, that the highest rate of recurrent disease appears to occur in the first 2 years after treatment.…”

“…In a meta-analysis by Ghaem-Maghami et al, 8 including 66 studies and involving 35 109 women, it was shown that after incomplete excision (any margin including uncertainty of margin status), the recurrence risk of any grade of post-treatment disease (histological or cytological) was 5.47. The median proportion of women with involved margins was 24% (interquartile range [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The pooled prevalence (histological or cytological) of post-treatment disease was 21% (336/1589) in those with involved endocervical margins, 16% (213/1374) in those with involved ectocervical margins, and 23% (99/434) when both margins were involved.…”

Predictors of recurrence in high-grade cervical lesions and a plan of management

“…With regard to obstetric prognosis, LEEP or conization increased the risk of preterm delivery and low birth weight but did not increase perinatal mortality. Sparing of cervical tissue leads to a variable number of incomplete resections, ranging from 7.8 to 31.8% according to the series (3,4). In most series, one of four treated patients had positive margins.…”