Residual lesions in uterine specimens after loop electrosurgical excision procedure in patients with CIN
- 119 Downloads
To identify the risk factors for residual lesion in hysterectomy specimens after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN).
Methods and results
We retrospectively analyzed the clinical data of 594 patients who underwent total hysterectomy after LEEP for CIN at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiaotong University between July 2006 and June 2015. Among the 594 patients, there were no residual lesions in uterine specimens of 409 (68.9%) patients; residual CIN1 was found in 24 (4%) patients, CIN2 and CIN3 in 142 (23.9%) patients, and cervical cancer in 19 (3.2%) patients. On univariate analysis age, menopausal status, margin involvement, lesion grade, abnormal endocervical curettage (ECC) result, and persistent human papillomavirus (HPV) infection post operation were significantly associated with residual lesions after LEEP (P < 0.05). Multivariate regression analysis using the logistic regression model showed abnormal ECC result and persistent HPV positivity to be independent risk factors for residual lesions after LEEP. LEEP with positive margins and persistent HPV infection were also associated with high risk of invasive cervical cancer in CIN2+ patients.
Abnormal ECC result and post-treatment HPV infection are predictors of residual lesion after LEEP. In combination, they could be useful for risk stratification and selection of the management approach. Postmenopausal CIN2+ patients with positive margins and persistent postoperative HPV infection may have high risk of cervical invasive cancer.
KeywordsCervical loop electrosurgical excision procedure (LEEP) Conization Hysterectomy Colposcopy Cervical intraepithelial neoplasia Margin involvement
Atypical glandular cells
Atypical glandular cells—favor neoplasia
Adenocarcinoma in situ
American Society for Colposcopy and Cervical Pathology
Atypical squamous cells—cannot exclude high-grade squamous intra-epithelial lesion
Cervical intraepithelial neoplasia
High-grade squamous intraepithelial lesion
Liquid-based cytology test
Loop electrosurgical excision procedure
Low-grade squamous intraepithelial lesion
Vaginal intraepithelial neoplasia
Wu Dan put forward the concept and idea;Lin Jing designed the experiment;Experiments were completed by Xu Ying and Chen Yi, Li Zhunan is responsible for detection;Lin Jing and Chen Yi summarized the data and conducted a statistical analysis;The essay was written by Lin Jing;Wu Dan proposed constructive amendments to the essay.
This study was funded by the Shanghai Shen Kang Hospital Development Center’s “Comprehensive prevention and control project of chronic disease in municipal hospitals”, 2015, Shanghai, China. [Grant number SHDC 12015312].
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
This study was approved by the institutional Ethics Committee of International Peace Maternal and Child Health Hospital. The date of approval is 2/8/2016 and the reference number is (GKLW) 2015–28. All study participants gave written informed consent.
- 7.Hamontri S, Israngura N, Rochanawutanon M, Bullangpoti S, Tangtrakul S (2010) Predictive factors for residual disease in the uterine cervix afterlarge loop excision of the transformation zone in patients with cervical intraepithelial neoplasia III. J Med Assoc Thai 93(Suppl 2):S74–S80PubMedGoogle Scholar
- 12.Ramchandani SM, Houck KL, Hernandez E, Gaughan JP (2007) Predicting persistent/recurrent disease in the cervix after excisional biopsy (J). Med Gen Med 9(2):24Google Scholar
- 19.Kietpeerakool C, Khunamornpong S, Srisomboon J, Siriaunkgul S, Suprasert P (2007) Cervical intraepithelial neoplasia ii–iii with endocervical cone margin involvement after cervical loop conization: is there any predictor for residual disease? J Obstet Gynaecol Res 33(5):660–664CrossRefPubMedGoogle Scholar
- 23.Kong TW, Son JH, Chang SJ, Paek J, Lee Y, Ryu HS (2014) Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia, adenocarcinoma in situ, and microinvasive carcinoma of the uterine cervix[J]. Gynecol Oncol 135(3):468–473CrossRefPubMedGoogle Scholar