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
Histologically confirmed CIN 2/3
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
Odds ratio (OR) 13.20 (95% CI, 1.02 to 170.96)
OR 15.84 (95% CI, 3.02 to 83.01)
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)
>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”
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