Predictors of cervical dysplasia after the loop electrosurgical excision procedure in an inner-city population.
OBJECTIVE
To identify factors associated with persistence or clearance of cervical intraepithelial neoplasia (CIN) following loop electrosurgical excision procedure (LEEP) in high-risk patients.


METHODS
In a retrospective database review, we identified 343 patients who had 2 LEEP procedures or LEEP followed by hysterectomy for CIN at Grady Memorial Hospital. We compared margin status, endocervical curettage (ECC) at LEEP and follow-up cytology for patients characterized as having persistent or nonpersistent dysplasia.


RESULTS
Seventy-nine percent (71/90) of patients with positive LEEP margins had persistent disease vs. 50% (45/90) with negative margins (odds ratio [OR]=3.7, 95% confidence interval [CI] 1.9-7.2, P<.0001). Ninety-one percent (29/32) with positive margins and positive ECC had persistent disease vs. 47% (26/55) with negative margins and negative ECC (OR=10.8, 95% CI 2.9-39.6, P<.0001). Sixty-eight percent (149/218) with at least 1 positive Pap smear following LEEP had persistent disease vs. 37% (11/30) with all negative follow-up Pap smears (OR = 3.7, 95% CI 1.7-8.3, P = .0007).


CONCLUSIONS
Although the risk of persistent CIN increased with positive LEEP margins, ECC and cytology, these variables, when negative, offered no ensurance of a future disease-free state in this high-risk population.
Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA. robinfogle@yahoo.com
Robin H
RH
Fogle
Cyril O
CO
Spann
Kirk A
KA
Easley
Jack B
JB
Basil
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D016017:Odds Ratio; D065006:Papanicolaou Test; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery*