title: Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years.
abstract: OBJECTIVE
  To establish the effect of margin status on recurrence following large loop excision of the transformation zone (LLETZ) in women over 50 years.
  
  
  METHODS
  Prospectively collected data of women over 50 years, who underwent LLETZ for suspected cervical intraepithelial neoplasia between 1998 and 2003, were analysed. Women were followed up for up to over 6 years.
  
  
  METHODS
  District colposcopy service based at a gynae-oncology cancer centre.
  
  
  METHODS
  The main outcome measure included histologically detected recurrence. Any abnormal cytology on follow up was also documented.
  
  
  METHODS
  Prospectively collected data were analysed from the colposcopy database. Recurrence was analysed using Kaplan-Meir plots and Cox regression. Fisher's exact test was used to determine the association between margins and grade. The Kruskal-Wallis and Mann-Whitney U tests were used to compare age and duration of follow up between groups.
  
  
  RESULTS
  A total of 118 women underwent LLETZ and 92 were included in the final analysis. Margins were designated as clear (n = 62), involved (n = 22) or uncertain (n = 8). Histological recurrence occurred in 12 while abnormal cytology was demonstrated in 17 women. One woman with involved margins developed cervical cancer. Individuals with clear margins were less likely to have recurrence than those with involved margins (Hazard Ratio (HR) 0.18, 95% CI: 0.06-0.59). Involved margins were more common with high-grade than low-grade lesions (P = 0.002).
  
  
  CONCLUSIONS
  The data show an association between disease recurrence and the finding of involved margins in this cohort.
authors: Department of Gynaecology, Division of Gynaecological Oncology, Addenbrooke's Hospital, Cambridge, UK. r.manchanda@ucl.ac.uk
authors: R
authors: R
authors: Manchanda
authors: P
authors: P
authors: Baldwin
authors: R
authors: R
authors: Crawford
authors: S L
authors: SL
authors: Vowler
authors: R
authors: R
authors: Moseley
authors: J
authors: J
authors: Latimer
authors: K
authors: K
authors: Welton
authors: M
authors: M
authors: Shafi
mesh_terms: D000368:Aged; D003127:Colposcopy / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*