title: Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III.
abstract: OBJECTIVE
  To determine the factors associated with subsequent intraepithelial neoplasia among patients who had cervical intraepithelial neoplasia grade III (CIN III) diagnosed on a specimen from previous large-loop excision of the transformation zone.
  
  
  METHODS
  We studied all large-loop excisions of the transformation zone performed between May 1991 and December 1993, inclusive. All cases of CIN III were identified. We followed up patients with cytology and colposcopy for 2 years after treatment for high-grade CIN. Findings at follow-up were analyzed.
  
  
  RESULTS
  A histologic diagnosis of CIN III was made in 225 patients. The lesion appeared incompletely excised in 105 patients (48.2%). In 76 cases (34.9%), CIN III was found at the endocervical margin. Of the 211 patients reviewed at 6 months, 18 (8.5%) had histologically proven CIN. The incidence of CIN was 16.5% after a report of incomplete excision, compared with 1.9% after a report of complete excision (P < .001). Furthermore, there was no subsequent CIN III in the complete-excision group. Of the 183 patients reviewed at 24 months, seven (3.8%) had histologically proven CIN. All cases of subsequent CIN were associated with dyskaryosis on follow-up cervical cytology.
  
  
  CONCLUSIONS
  Positive margins increase the risk of treatment failure. Cytology alone may be adequate for follow-up when CIN III is completely excised.
authors.affiliation: Coombe Women's Hospital, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Gardeil
authors.forename: C
authors.initials: C
authors.lastname: Barry-Walsh
authors.forename: W
authors.initials: W
authors.lastname: Prendiville
authors.forename: J
authors.initials: J
authors.lastname: Clinch
authors.forename: M J
authors.initials: MJ
authors.lastname: Turner
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*