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Residual lesions in uterine specimens after loop electrosurgical excision procedure in patients with CIN

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

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.

Conclusions

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.

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Abbreviations

AGC:

Atypical glandular cells

AGC-FN:

Atypical glandular cells—favor neoplasia

AIS:

Adenocarcinoma in situ

ASCCP:

American Society for Colposcopy and Cervical Pathology

ASC-H:

Atypical squamous cells—cannot exclude high-grade squamous intra-epithelial lesion

CIN:

Cervical intraepithelial neoplasia

ECC:

Endocervical curettage

HPV:

Human papillomavirus

HSIL:

High-grade squamous intraepithelial lesion

LCT:

Liquid-based cytology test

LEEP:

Loop electrosurgical excision procedure

LSIL:

Low-grade squamous intraepithelial lesion

VaIN:

Vaginal intraepithelial neoplasia

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Funding

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].

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Authors and Affiliations

  1. Department of Cervical Disease, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, 910 Hengshan Road, Shanghai, 200030, China

    Lin Jing, Wu Dan, Li Zhunan, Xu Ying & Chen Yi

Authors
  1. Lin Jing
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  2. Wu Dan
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  3. Li Zhunan
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  4. Xu Ying
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  5. Chen Yi
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Contributions

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.

Corresponding author

Correspondence to Wu Dan.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical disclosures

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.

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Jing, L., Dan, W., Zhunan, L. et al. Residual lesions in uterine specimens after loop electrosurgical excision procedure in patients with CIN. Arch Gynecol Obstet 298, 805–812 (2018). https://doi.org/10.1007/s00404-018-4881-7

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  • DOI: https://doi.org/10.1007/s00404-018-4881-7

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