'See and treat' regime by LEEP conisation is a safe and time saving procedure among women with cytological high-grade squamous intraepithelial lesion.
BACKGROUND
Assess the value of colposcopic evaluation preceding loop electrosurgical excision procedure (LEEP) conisation of cytological high grade squamous intraepithelial lesion (HSIL), and study risk factors for recurrence.


METHODS
Consecutive follow-up among women undergoing LEEP conisation from January 2001 to December 2004.


RESULTS
Some 528 LEEP conisations were performed because of suspected or verified cervical dysplasia. On classified samples, cytology, punch biopsy and histopathology of the cone specimen showed cervical intraepithelial neoplasia (CIN)2 or a higher degree in 48.5, 36.2 and 58.6%, respectively. Sensitivity for HSIL out of cytology and colposcopically directed punch biopsy was 74.4 and 73.3%, respectively. Likewise, among 286 women with all 3 samples, positive and negative predictive value for HSIL in Papanicolaou (Pap) smear and punch biopsy was 78.5, 73.2% and 60.3, 63.6%, respectively. Positive cone margins were found in 16.8%. Residual/recurrent disease, defined as any grade of dysplasia at cytological follow-up, was found among 9.4%. Significant risk for recurrent/residual disease was found among those with positive marginal status. Median time from colposcopy to conisation was 2 months.


CONCLUSIONS
An immediate colposcopically-guided LEEP conisation after HSIL Pap smear may be a safe and time saving strategy. Positive cone margins are a risk factor for residual/recurrent disease.
Kjellberg
Lennart
L
Department of Obstetrics and Gynaecology, Umeå University Hospital, Umeå, Sweden. lennart.kjellberg@obgyn.umu.se
Tavelin
Björn
B
D000328:Adult; D001707:Biopsy, Needle; D003127:Colposcopy / Q000379:methods; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications*; D012307:Risk Factors; D012449:Safety; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery* / Q000821:virology