Multivariate analysis of risk factors for the persistence of high-grade squamous intraepithelial lesions following loop electrosurgical excision procedure.

OBJECTIVE

To evaluate risk factors related to the persistence of high-grade squamous intraepithelial lesions (HSILs) following loop electrosurgical excision procedure (LEEP).

METHODS

The present prospective, observational study evaluated a convenience sample of participants with HSILs who were treated using LEEP between January 7, 2003 and December 30, 2011. Participants were evaluated 6months and 1year after treatment. Potential risk factors included in multivariate analyses were HIV co-infection, involved margins, multicentric lesions, smoking, and use of hormonal contraception.

RESULTS

The present study enrolled 307 participants. At 1year, 250 (81.4%) participants were free from lesions, 30 (9.8%) had low-grade squamous intraepithelial lesions, 26 (8.5%) had persistent HSILs, and 1 (0.3%) had developed invasive carcinoma. The risk of lesions persisting at 1year after LEEP was increased by HIV infection (P=0.003), involved margins (P=0.05), and smoking (P=0.02). The presence of multicentric lesions (P=0.73) and the use of hormonal contraception (P=0.99) did not increase the risk of lesion persistence. The risk of HSIL persistence was increased by the presence of involved margins (relative risk 3.25; 95% confidence interval 1.55-6.80; P=0.001).

CONCLUSIONS

The presence of involved margins was the only variable that increased the risk of HSIL persistence after LEEP, increasing the risk of patients requiring further treatment.