Significance of disease extent in high-grade cervical intraepithelial neoplasia excised with negative margins by loop electrosurgical excision procedure☆

Abstract 

Approximately 15% of patients with high-grade cervical intraepithelial neoplasia (CIN 2-3), treated by the loop electrosurgical excision procedure (LEEP) will experience a persistence or recurrence of their disease. The full spectrum of pathologic factors that may be predictive of an increased probability of this event remains to be elucidated. In this work, we evaluate the significance of disease extent in a group of patients with CIN 2 to 3 that was completely excised by LEEP (ie, endocervical and ectocervical margins were negative). From 102 patients whose LEEP specimens had negative margins during a 5-year period, at least 1 cytologic follow-up was available in 87 patients (median follow-up, 23 months). For patients with multiple follow-up cytologic samples, the most severe cytologic abnormality was used for the purpose of this analysis (1 sample per patient). Extent of disease was determined semiquantitatively by calculating for every case the proportion of processed slides on which any CIN 2 to 3 could be identified. The 87 cases were classified into 3 groups (<33%, 33%-66%, >66%) for ease of statistical comparison (Fisher exact test). There were 10 recurrences of high-grade squamous intraepithelial lesion (HGSIL) among the 87 patients with follow-up. There were no statistically significant differences between the aforementioned 3 groups regarding the follow-up diagnostic frequencies of HGSIL (10% in the <33% group, 40% in the 33%-66% group, and 50% in the >66% group) and “negative for intraepithelial lesion or malignancy” (32.25% in the <33% group, 25.8% in the 33%-66% group, and 35.48% in the >66% group). If confirmed, our findings suggest that in an LEEP specimen with CIN 2 to 3 that was excised with negative margins, the extent of disease lacks prognostic significance and need not be reported.

Keywords: Cervix, Loop electrosurgical excision procedure, Cone biopsy, Cervical intraepithelial neoplasia, Human papillomavirus, Quadrants, Extent of disease