The value of the endocervical margin status in LEEP: analysis of 610 cases

Mirandez, Camila Castelhano; Yoneda, Juliana Yoko; Gertrudes, Larissa Nascimento; Carvalho, Carla Fabrine; Derchain, Sophie Françoise Mauricette; Vale, Diama Bhadra

doi:10.1007/s00404-022-06464-w

Cited by 2 publications

(1 citation statement)

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“…Previous studies have confirmed that a positive LEEP margin is closely related to residual lesions of the uterus, in which 30–90% of residual lesions of the uterus have positive LEEP margins, and 83% have positive endo-cervical margins [ 10 , 14 , 20 , 21 ]. In our study, the endo-cervical margin was positive in 51% (74/145) of patients, and we found that up to 68.4% (145/212) of patients had positive margins, while 81.3%(61/75) of patients with residual disease after hysterectomy had positive margins.…”

Section: Discussionmentioning

confidence: 96%

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

Wang,

2024

BMC Women's Health

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Background The purpose of this study was to predict the risk factors for residual lesions in patients with high-grade cervical intraepithelial neoplasia who underwent total hysterectomy. Methods This retrospective study included 212 patients with histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2-3) who underwent hysterectomy within 6 months after loop electrosurgical excision procedure (LEEP). Clinical data (e.g., age, menopausal status, HPV type, and Liquid-based cytology test(LCT) type), as well as pathological data affiliated with endocervical curettage (ECC), colposcopy, LEEP and hysterectomy, were retrieved from medical records. A logistic regression model was applied to estimate the relationship between the variables and risk of residual lesions after hysterectomy. Results Overall, 75 (35.4%) patients had residual lesions after hysterectomy. Univariate analyses revealed that positive margin (p = 0.003), glandular involvement (p = 0.017), positive ECC (p < 0.01), HPV16/18 infection (p = 0.032) and vaginal intraepithelial neoplasia (VaIN) I-III (p = 0.014) were factors related to the presence of residual lesions after hysterectomy. Conversely, postmenopausal status, age ≥ 50 years, ≤ 30 days from LEEP to hysterectomy, and LCT type were not risk factors for residual lesions. A positive margin (p = 0.025) and positive ECC (HSIL) (p < 0.001) were identified as independent risk factors for residual lesions in multivariate analysis. Conclusions Our study revealed that positive incisal margins and ECC (≥ CIN2) were risk factors for residual lesions, while glandular involvement and VaIN were protective factors. In later clinical work, colposcopic pathology revealed that glandular involvement was associated with a reduced risk of residual uterine lesions. 60% of the patients with residual uterine lesions were menopausal patients, and all patients with carcinoma in situ in this study were menopausal patients. Therefore, total hysterectomy may be a better choice for treating CIN in menopausal patients with positive margins and positive ECC.

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