Incomplete excision of cervical intraepithelial neoplasia as a predictor of the risk of recurrent disease—a 16-year follow-up study

Impact of endocervical surgical margin in the treatment of dysplastic cervical lesions

“…The comparison over the time between patients with negative and positive margins confirmed that patients with positive endocervical margins have a greater risk of persistence/recurrence of disease than those with negative margins [25,37,38]. In our study the recurrence rate was 8.2% and this is in line with the overall average of 7% found in the most recent meta-analysis [34] and the median proportion of 9% in an earlier meta-analysis [36,37].…”

Role of Colposcopy after Treatment for Cervical Intraepithelial Neoplasia

“…Follow-up with the hrHPV test and restriction of colposcopy for HPV-positive women only might be an acceptable approach here as well. Repeated LLETZ procedures should perhaps be restricted to cases where there is histological confirmation of residual disease or persistent hrHPV positivity after the treatment along with affected margins, and these conclusions are supported by previous literature [ 9 , 20 ].…”

“…This is contradictory to other studies, where the probability of recurrence has been reported to be higher if the endocervical margin was affected [ 9 , 44 ], although in some studies the risk of recurrent disease was the same irrespective which margin was affected [ 42 , 45 ]. A recent register-based study reported women with involved margins to be at increased risk for recurrent disease; however, the risk was not increased, if only the ectocervical margin was affected [ 20 ]. In our study, almost half of the patients with positive endocervical margins had a repeated LLETZ versus 21 % of the cases who had an affected ectocervical margin, but our total numbers here are low and conclusions should be prudent.…”

“…The presence or absence of hrHPV is an accurate method to predict treatment failure or cure [ 9 , 16 , 17 , 18 ] also when compared to cytology and margin status [ 19 , 20 , 21 , 22 ]. Furthermore, affected, or positive, resection margins of the excised cone are associated with an increased risk of treatment failure [ 12 , 22 ], while a recent meta-analysis found the subsequent hrHPV test to be the most accurate method to predict treatment outcome [ 9 ].…”

What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status?

“…In turn, cone margin status affects post-treatment outcomes. Many previous studies have evaluated associations between cone margin involvement and risk of residual/recurrent CIN2+ [1,5,6]. Conversely, fewer studies have been published concerning the risk factors for positive or negative cone margins.…”