Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective studyReport as inadecuate




Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 15:744

First Online: 20 October 2015Received: 24 May 2015Accepted: 09 October 2015DOI: 10.1186-s12885-015-1748-1

Cite this article as: Zhu, M., He, Y., Baak, J.P. et al. BMC Cancer 2015 15: 744. doi:10.1186-s12885-015-1748-1

Abstract

BackgroundIn 5–20 % of patients with cervical high-grade squamous intraepithelial lesion HSIL, a positive margin after the loop electrosurgical excision procedure LEEP is associated with persistence-recurrence, but the prognostic value of other clinico-pathological factors is less clear.

MethodsAmong 4336 patients with HSIL who underwent an initial LEEP, 275 6 % had HSIL-positive margins, 37 of whom were lost to follow-up. We evaluated the remaining 238 patients. Persistence-recurrence was defined as histopathological HSIL during follow-up.

ResultsThe age of the patients ranged from 21 to 69 years median: 40. The median follow-up period was 25 months range: 6–43. Of the 238 patients, 211 88.7 % patients remained free of persistence-recurrence, while 27 11.3 % experienced persistence-recurrence. According to a univariate analysis, age P = 0.03 and maximum specimen diameter P = 0.043 were associated with persistence-recurrence, but number-location of involved margin sections and the pathology of the endocervical curettage were not P > 0.10. The relative risk of the subjects greater than or equal to 35 years ages was 4.6 times of the subject less than 35 years, the difference was statistically significant 14 % vs. 3 %, P < 0.05. A multivariate analysis indicated that an age of 35 years or older was the only independent risk factor OR 4.97, 95 % CI 1.14–21.62, P = 0.03.

ConclusionIn patients with HSIL and HSIL-involved margins after an initial LEEP, age is a strong independent predictor of persistence-recurrence. Follow-up with screening cytology and-or biopsy may be considered in younger patients, whereas a secondary LEEP-hysterectomy may be considered in older patients.

KeywordsHSIL LEEP Positive margins Recurrence Persistence Follow-up AbbreviationsHSILHigh-grade squamous intraepithelial lesion

LEEPLoop electrosurgical excision procedure

LSILLow-grade squamous intraepithelial lesion

CINCervical intraepithelial neoplasia

ECCEndocervical curettage

HPVHuman papilloma virus

OROdd ratio

CIConfidence interval

ASCCPAmerican Society for Colposcopy and Cervical Pathology

Menghan Zhu and Weiwei Feng contributed equally to this work.

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Author: Menghan Zhu - Yuan He - Jan PA Baak - Xianrong Zhou - Yuqing Qu - Long Sui - Weiwei Feng - Qing Wang

Source: https://link.springer.com/







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