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Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP)

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

Abstract

Purpose

Conization for suspected high grade cervical intraepithelial neoplasia (CIN) is often performed based on abnormal cytology only. Loop electrosurgical excision procedure (LEEP) is a very common technique in this context. The present study analyses the accuracy of preoperative assessment of CIN with cytology plus colposcopic biopsy and assesses the efficacy of LEEP for the treatment of CIN.

Methods

Two-hundred and sixty-six consecutive patients treated with LEEP for suspected CIN at our center were retrospectively analyzed. Cytology, HPV-DNA testing, colposcopically directed cervical biopsy and/or endocervical curettage were performed to assess cervical lesions before and 3–6 months after surgery.

Results

Median age of the patients was 34 years. Median follow-up was 50 months. Preoperative HPV testing was positive for high risk types in 77.9 %. All patients underwent LEEP without further ablative procedures. Complete excision of the lesion could be achieved in 84.3 %; in 13.5 % margins were not securely cleared and in 2.2 % the lesion was not excised entirely. Overall complication rate was 5.4 % (mainly postoperative bleeding and pain). Overall concordance of colposcopic biopsy and cone histology was 85.8 %. The concordance rate was higher for CIN 2/3 (95.1 %) compared with CIN 1 (63.2 %). Nine patients (3.4 %) had persistent disease after 3 months, 4 (1.5 %) developed disease recurrence and underwent re-conization. HPV testing at 3–6 months after surgery was negative in 78.5 %; 2 of the patients developing disease recurrence had a persistent HPV infection after surgery.

Conclusions

Assessment of cervical lesions with colposcopic biopsy is an accurate method (concordance with cone histology 85.8 %). Surgical treatment of high grade CIN with LEEP is a safe procedure with low recurrence rates, resulting in a clearance of cervical HPV infection in the majority of cases.

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Acknowledgments

This study was funded by internal departmental sources.

Conflict of interest

All authors declare that there is no conflict of interest involved with the presented data. The study was funded by internal departmental sources.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Nina Duesing, Joerg Schwarz, Fritz Jaenicke, Friederike Gieseking, Sven Mahner & Linn Woelber

  2. Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Matthias Choschzick & Rana Issa

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  1. Nina Duesing
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  2. Joerg Schwarz
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Correspondence to Linn Woelber.

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Duesing, N., Schwarz, J., Choschzick, M. et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet 286, 1549–1554 (2012). https://doi.org/10.1007/s00404-012-2493-1

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  • DOI: https://doi.org/10.1007/s00404-012-2493-1

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