BACKGROUND AND PURPOSE:

• Long-term risk for CIN recurrence following large loop excision of the transformation zone (LLETZ) remains unclear
• Fernández-Montolí et al. (BJOG, 2019) examined the long-term risk factors associated with
  • Recurrent cervical intraepithelial neoplasia (CIN 2/3)
  • Time to recurrence after LLETZ

METHODS:

• Retrospective study
  • 1996 and 2006 with follow-up until 2016
• Participants
  • Women with CIN 2/3
  • Consecutively treated with LLETZ
• Study design
  • Loop size based on the tissue to be excised
    • Second selective EC sweep with a smaller loop if the transformation zone was type 3 or if the patient >35 years
  • Residual/recurrent disease was defined as CIN 2/3 diagnosed by cervical biopsy or endocervical curettage | CIN2 and CIN3 combined due to anticipated small ‘n’
  • Logistic regression models used to estimate
    • Age | Margins | Association with high-risk human papillomavirus (HR-HPV)
• Primary outcome
  • Histologically confirmed CIN 2/3

RESULTS:

• 242 women included
• CIN 2/3 following LLETZ was associated with
  • HR-HPV after LLETZ: HR 30.5 (95% CI, 3.80 to 246.20; P < 0.001)
    • Sensitivity of 88.8%; specificity of 80%
  • Age >35 years: HR 5.53 (95% CI, 1.22 to 25.13; P = 0.009)
  • Involved margins: HR 7.31, 95% CI = 1.60 to 33.44; P = 0.003)
• The following margins had a higher risk of recurrence
  • Ecto+/endocervical+: 16.7%
    • Odds ratio (OR) 13.20 (95% CI, 1.02 to 170.96)
  • Uncertain: 19.4%
    • OR 15.84 (95% CI, 3.02 to 83.01)
  • Ecto−/endocervical+: 9.1%
    • OR 6.60 (95% CI, 0.88 to 49.53)
• Women with involved margins and/or who were HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log-rank <0.001)

CONCLUSION:

• >35 years, HR-HPV positive and involved margins are at a higher risk of CIN 2/3 recurrence post-LLETZ
• Post-treatment HR-HPV has a demonstrated a higher sensitivity and NPV than cytology or margins for detecting the residual or recurrent CIN
• Authors suggest risk factors such as age should be taken into account, including larger excision in older women to obtain clear margins |  “HR-HPV and margin statuses can be used to stratify the post-LLETZ risk of recurrence and enable personalised management”

Learn More – Primary Sources:

Long-term predictors of residual or recurrent cervical intraepithelial neoplasia 2–3 after treatment with a large loop excision of the transformation zone: a retrospective study

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