Analysis of Residual/Recurrent Disease and Its Risk Factors after Loop Electrosurgical Excision Procedure for High-Grade Cervical Intraepithelial Neoplasia.

AIM

The aim of this study was to analyze residual/recurrent disease and its risk factors as well as the appropriate frequency of follow-up cytology and human papillomavirus (HPV) tests after loop electrosurgical excision procedure (LEEP) for CIN2/3.

METHODS

We retrospectively analyzed 835 patients with CIN2/3 who were treated with LEEP. Post-LEEP follow-up was performed using liquid-based cytology tests or/and HPV DNA tests. Residual/recurrent disease was defined as biopsy-proven CIN2/3; cervical cancer and vulval intraepithelial neoplasia were not considered as residual/recurrent cases.

RESULTS

CIN2/3 was detected in 19/835 (2.3%) patients during follow-up. In multivariate logistic regression analysis, post-treatment CIN2/3 was significantly more likely in cases of preoperative HPV-16 infection (OR 8.208, 95% CI 1.514-44.489), positive excision margins (OR 4.811, 95% CI 1.154-20.258), persistent HPV infection (OR 5.231, 95% CI 1.141-23.976) and abnormal liquid-based cytology tests at 3-month follow-up (OR 16.495, 95% CI 3.689-73.764).

CONCLUSION

Some factors, such as HPV-16 infection, positive excision margins, persistent HPV infection and abnormal liquid-based cytology tests at 3-month follow-up, appeared to be strong risk factors for residual/recurrent CIN2/3 after LEEP. Therefore, patients who undergo LEEP for CIN and follow-up 3 months after LEEP should be assessed for these high-risk factors.