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.

Keywords:
Cytology tests, Risk factor, Loop electrosurgical excision procedure, Cervical intraepithelial neoplasia, Human papillomavirus
1.
McCredie MR, Sharples KJ, Paul C, et al: Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol 2008;9:425-434.
2.
Prendiville W, Cullimore J, Norman S: Large loop excision of the transformation zone (LLETZ): a new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol 1989;96:1054-1060.
3.
Wright TC Jr, Massad LS, Dunton CJ, et al: 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol 2007;197:340-345.
4.
Rivoire WA, Monego HI, Dos Reis R, et al: Comparison of loop electrosurgical conization with one or two passes in high-grade cervical intraepithelial neoplasias. Gynecol Obstet Invest 2009;67:228-235.
5.
Wu D, Zheng Y, Chen W, et al: Prediction of residual/recurrent disease by HPV genotype after loop excision procedure for high-grade cervical intraepithelial neoplasia with negative margins. Aust NZ J Obstet Gynaecol 2011;51:114-118.
6.
Ghaem-Maghami S, Sagi S, Majeed G, et al: Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol 2007;8:985-993.
7.
Massad LS, Einstein MH, Huh WK, et al; 2012 ASCCP Consensus Guidelines Conference: 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013;17(suppl 1):S1-S27.
8.
Soutter WP, Sasieni P, Panoskaltsis T: Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer 2006;118:2048-2055.
9.
Strander B, Andersson-Ellström A, Milsom I, et al: Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study. BMJ 2007;335:1077.
10.
Mitchell MF, Tortolero Luna G, Cook E, et al: A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol 1998;92:737-744.
11.
Li H, Guo YL, Zhang JX, et al: Risk factors for the development of vaginal intraepithelial neoplasia. Chin Med J (Engl) 2012;125:1219-1223.
12.
Ryu A, Nam K, Kwak J, et al: Early human papillomavirus testing predicts residual/recurrent disease after LEEP. J Gynecol Oncol 2012;23:217-225.
13.
Kim J, Kim BK, Lee CH, et al: Human papillomavirus genotypes and cofactors causing cervical intraepithelial neoplasia and cervical cancer in Korean women. Int J Gynecol Cancer 2012;22:1570-1576.
14.
Verguts J, Bronselaer B, Donders G, et al: Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG 2006;113:1303-1307.
15.
Zhao C, Hong W, Li Z, et al: Human papillomavirus testing and cytologic/histopathologic ‘test of cure' follow-up results after excisional treatment for high-grade cervical intraepithelial neoplasia. J Am Soc Cytopathol 2014;3:15-20.
16.
Gao K, Eurasian M, Zhang J, et al: Can genomic amplification of human telomerase gene and C-MYC in liquid-based cytological specimens be used as a method for opportunistic cervical cancer screening? Gynecol Obstet Invest DOI: 10.1159/000371760.
17.
Kir G, Karabulut M, Yilmaz M, et al: Cytohistological correlation of endocervical gland involvement with high-grade squamous intraepithelial lesions. J Cytol 2012;29:121-124.
18.
Kang WD, Oh MJ, Kim SM, et al: Significance of human papillomavirus genotyping with high-grade cervical intraepithelial neoplasia treated by a loop electrosurgical excision procedure. Am J Obstet Gynecol 2010;203: 72.e1-72.e6.
19.
Khan MJ, Castle PE, Lorincz AT, et al: The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005;97:1072-1079.
20.
Gök M, Coupé VM, Berkhof J, et al: HPV16 and increased risk of recurrence after treatment for CIN. Gynecol Oncol 2007;104:273-275.
© 2015 S. Karger AG, Basel
2015
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