Tools for Post LEEP Surveillance

Bornstein, Jacob; Schwartz, Jacob; Perri, Alexander; Harroch, Jefferey; Zarfati, Doron

doi:10.1097/01.ogx.0000137612.87012.66

Cited by 9 publications

(6 citation statements)

References 56 publications

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“…In recent years, several studies have shown that HPV DNA testing is a significant predictor of residual/recurrent disease 20–26 . In a review of 11 studies, sensitivity of HPV DNA testing in detecting residual/recurrent disease reached 100% in four studies, whereas the specificity of the test ranged from 44% to 95%.…”

Section: Discussionmentioning

confidence: 99%

Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

et al. 2009

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Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasiaObjective: To assess the role of human papillomavirus (HPV) testing and cytology as predictors of residual ⁄ recurrent disease after treatment of high-grade cervical intraepithelial lesions. Methods: One hundred and thirty-eight women with cervical intraepithelial neoplasia (CIN) grade 2 ⁄ 3 lesion on biopsy were included in a prospective follow-up study in Belgium and Nicaragua. All women were treated with loop electrosurgical excision procedure (LEEP) and follow-up visits took place at 6 weeks, 6 months, 1 year and 2 years. During these visits, a Papanicolaou (Pap) smear test was taken, colposcopy was performed and specimens were collected for HPV testing. Cytology, high-risk (HR) HPV presence, persistent HR HPV infection and combinations of these tests at different time points during follow-up were correlated with histologically confirmed residual ⁄ recurrent disease. Results: Thirteen patients (9%) developed residual ⁄ recurrent disease during follow-up. Abnormal cytology at 6 weeks after treatment was significantly correlated with residual ⁄ recurrent disease. Nine of thirty-seven patients with abnormal cytology at 6 weeks had recurrent disease versus three of seventy with a normal cytology [odds ratio (OR): 7.2; 95% confidence interval (CI): 1.8-28.5; P = 0.003). Sensitivity of this test was 75.0%, specificity 70.5%. Combining abnormal cytology and the presence of HR HPV within the first 6 months after treatment gave the best correlation with residual ⁄ recurrent disease: of the 54 women with abnormal cytology and ⁄ or HR HPV presence within the first 6 months, 11 developed residual ⁄ recurrent disease (OR 10.2; 95% CI: 2.2-48.3). Sensitivity of this combination was 84.6% and specificity 65.0%. Conclusion: Cytology remains the cornerstone in the early follow-up after LEEP for CIN lesions of the cervix. HPV testing can add value as it increases the sensitivity of cytology in concomitant testing within the first 6 months.

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Section: Discussionmentioning

confidence: 99%

Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

et al. 2009

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“…Although follow-up after conization and early detection of treatment failure are important, till date, no standardized follow-up protocol has been developed. Margin involvement, age, menopausal status, human papillomavirus (HPV) persistence and cytological grade are reportedly risk factors for CIN persistence or recurrence after conization [ 6 , 8 , 9 ]. Although the resection margin during conization is considered to be the most important predictor of recurrent disease in patients who undergo cervical conization [ 6 ], several studies have reported that CIN persistence or recurrence is independent of margin involvement [ 8 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Laser Conization for Cervical Intraepithelial Neoplasia 2-3 and Microinvasive Cervical Cancer

et al. 2014

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BackgroundCurrently, there is no standardized follow-up protocol for patients who undergo laser conization. Therefore, we retrospectively investigated the clinical outcomes of laser conization in patients with high-grade cervical intraepithelial neoplasia 2-3 (CIN 2-3) and microinvasive squamous cell carcinoma and assessed the risks of residual and recurrent lesions of the cervix uteri.MethodsThe medical and pathological records of 91 patients with CIN 2, 580 with CIN 3 and 73 with microinvasive cervical cancer (MIC) who underwent laser conization between January 2000 and December 2011 were retrospectively reviewed.ResultsPositive margins increased with the extent of disease and were observed in 5.5%, 8.9% and 16.4% patients with CIN 2, CIN 3 and MIC, respectively, while residual or recurrent disease was observed in 0%, 3.2% and 13.6% patients, respectively. Examination of specimens obtained through postconization biopsy or hysterectomy revealed that 1.5% and 20% patients with negative and positive margins, respectively, were diagnosed with residual or recurrent lesions. Among patients who were conservatively managed after conization, seven with CIN 3 exhibited residual or recurrent disease, as evidenced by abnormal cytological findings, within 2 years after conization.ConclusionsContinuous follow-up by cytology and colposcopy, particularly during the first 2 years after conization, can effectively detect early residual or recurrent disease in CIN 3 and MIC patients, regardless of their margin status.

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“…What is not clear is the value that colposcopy would add over cytology alone for follow-up given the additional anxiety to patients and increased treatment rates. In face of the increasing body of literature, which suggests high anxiety rates and default from appointments when colposcopy was involved, it is important that these women at high risk for recurrent CIN and invasive disease be offered follow-up strategies, which increase compliance and decrease stress [9,10].…”

Section: Discussionmentioning

confidence: 99%

Cytological Follow-up of Women Older than 50 Years With High-Grade Cervical Smear Treated by Large Loop Excision

Das

Sutton

Bevan

et al. 2009

Journal of Lower Genital Tract Disease

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Tools for Post LEEP Surveillance

Cited by 9 publications

References 56 publications

Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

Outcomes of Laser Conization for Cervical Intraepithelial Neoplasia 2-3 and Microinvasive Cervical Cancer

Cytological Follow-up of Women Older than 50 Years With High-Grade Cervical Smear Treated by Large Loop Excision

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