See-and-Treat Loop Electrosurgical Excision Procedure for High-Grade Cervical Cytology

Abstract Purpose: The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing HPV testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP. Methods: In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed. Results: Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. Of the 31 (14%) who were seen in a subsequent visit, 7 (3.2%) underwent further treatment for high-grade disease (CIN 2/3). The remaining 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. Conclusion: In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.

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

BMC Cancer ◽

10.1186/s12885-015-1748-1 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 17

Author(s):

Menghan Zhu ◽

Yuan He ◽

Jan PA Baak ◽

Xianrong Zhou ◽

Yuqing Qu ◽

...

Keyword(s):

Retrospective Study ◽

High Grade ◽

Squamous Intraepithelial Lesion ◽

Positive Margins ◽

Intraepithelial Lesion ◽

Loop Electrosurgical Excision ◽

Loop Electrosurgical Excision Procedure

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Recurrence after Treatment by Loop Electrosurgical Excision Procedure (LEEP) of High-Grade Cervical Intraepithelial Neoplasia

Tumori Journal ◽

10.1177/030089160208800609 ◽

2002 ◽

Vol 88 (6) ◽

pp. 478-480 ◽

Cited By ~ 10

Author(s):

Silvia Cecchini ◽

Carmen Beatriz Visioli ◽

Marco Zappa ◽

Stefano Ciatto

Keyword(s):

Recurrence Rate ◽

Screening Program ◽

Intraepithelial Neoplasia ◽

First Year ◽

Time Interval ◽

High Grade ◽

Independent Association ◽

Loop Electrosurgical Excision ◽

Loop Electrosurgical Excision Procedure

Purpose To evaluate the recurrence rate of high-grade CIN treated by loop electrosurgical excision procedure (LEEP) and the optimal follow-up schedule. Method 622 cases of CIN2/3 consecutively treated by LEEP in the Florence screening program, with 66.5 months average follow-up (range, 6–195 months), were evaluated. Recurrence was defined as histological evidence of high-grade CIN. Results The average recurrence rate was 9.1% (52 cases). Recurrence was significantly associated to increasing age (χ2 = 12.73, df = 3, P < 001), CIN grade (10.5 vs 6.1%, χ2 = 3.37, df = 1, P = 0.067), and time interval, with the risk of developing a recurrence highest in the first year (7.4%, 95% confidence interval, 5.3–9.5%.), and rare beyond the third year. Multivariate analysis confirmed a significant independent association of age (particularly over age 40) and CIN grade to the risk of recurrence. Conclusions LEEP is an effective procedure for the treatment of high-grade CIN. Most recurrences after LEEP occur in the first 3 years, and non-recurrent cases at that date may stop intensive follow-up and return to current cytological screening every 3 years.

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