More isn’t always better: Risk of recurrent high-grade squamous intraepithelial lesions after single-pass loop electrosurgical excision procedure (LEEP) versus LEEP with top hat (398)

Recurrent High-Grade Squamous Intraepithelial Lesion After Loop Excision Procedure Versus Loop Procedure With Top Hat

“…At 2 years of follow-up, there was no difference in rates of recurrent HSIL cytology in LEEP-SP compared with LEEP-TH. This study contributes to evidence that there is limited clinical value to performing a top hat at the time of LEEP excision in most patients (8)(9)(10). Another study found conflicting results to ours, but they were specifically looking at women with type 3 transformation zones, in whom all or parts of the transformation zone could not be fully visualized, which may be a confounding factor.…”

“…7 In the intervening decades, there has been much research and literature devoted to the optimization of treating cervical dysplasia; however, surgical practice still varies widely among practitioners with only a few published studies exploring the value of the top hat. These studies have divergent findings, with some studies showing lower rates of positive margins with the performance of a top hat and others showing no difference in treatment failure rates, [8][9][10][11][12] and there exists no clear consensus on which, if any, patients would benefit from a LEEP with top hat (LEEP-TH) versus a single pass (LEEP-SP).…”

"Clangorous and Inbred-High Grade Squamous Intraepithelial Lesion-Uterine Cervix"

“…Squamous intraepithelial lesion of uterine cervix is graded as ~low grade squamous intraepithelial lesion (LSIL) ~high grade squamous intraepithelial lesion (HSIL) [1,2]. High grade squamous intraepithelial lesion is subdivided into ~cervical intraepithelial neoplasia grade II (CIN II) which is associated with significant proportionate lesion retrogression.…”

“…~cervical intraepithelial neoplasia grade III (CIN III) is especially encountered in young women. CIN III delineates diffuse, basal and parabasal subtypes and appears devoid of maturation comprehensively across stratified squamous epithelial cell layers [1,2]. High grade squamous epithelial lesion (HSIL) commonly incriminates women within reproductive age group and demonstrates an estimated prevalence of up to 1%.…”

“…Characteristically, high grade squamous intraepithelial lesion (HSIL) occurs within older subjects, in contrast to low grade squamous epithelial lesion (LSIL). Factors contributing to occurrence of high grade squamous intraepithelial lesion (HSIL) appear as infection with human immunodeficiency virus (HIV), immunosuppression or tobacco consumption as cigarette smoking [2,3]. High grade squamous intraepithelial lesion (HSIL) predominantly arises within transformation zone and implicates cells configuring squamo-columnar junction or columnar epithelial cells.…”