title: Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ).
abstract: OBJECTIVE
  To assess the compliance of HSIL patients to the national Dutch routine follow-up protocol in the first 2 years after LLETZ and to determine if based on the status of excision margins, follow-up intervals could be modified.
  
  
  METHODS
  A prospective cohort study was performed in patients, referred because of an abnormal Pap smear between 1996 and 2004 and treated for HSIL with LLETZ. The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 months, respectively. Follow-up results were completed by using PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands. To assess compliance to the follow-up protocol, adequate follow-up was defined as three cervical smears taken after 6 (+/-3), 12 (+/-3) and 24 (+/-3) months, respectively.
  
  
  RESULTS
  Compliance to the first 2 years follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second and third follow-up cervical smears, respectively. Patients with involved excision margins had a three times higher overall risk of developing a subsequent HSIL after LLETZ as compared to patients with free excision margins (HR: 3.2, 95% CI=1.3-7.9, p=0.01). Risk for diagnosing HSIL during the first 12 months of follow-up for patients with free excision margins was only 1%.
  
  
  CONCLUSIONS
  Compliance to the Dutch national routine follow-up protocol in HSIL patients after LLETZ is only moderate. For HSIL patients with free excision margins after LLETZ the first cytological follow-up interval can safely be increased to 12 months.
authors.affiliation: Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J J H
authors.initials: JJ
authors.lastname: Eijsink
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
authors.forename: J L
authors.initials: JL
authors.lastname: Kuiper
authors.forename: N
authors.initials: N
authors.lastname: Reesink-Peters
authors.forename: B M
authors.initials: BM
authors.lastname: van Hemel
authors.forename: H
authors.initials: H
authors.lastname: Hollema
authors.forename: H W
authors.initials: HW
authors.lastname: Nijman
authors.forename: M J E
authors.initials: MJ
authors.lastname: Mourits
authors.forename: A G J
authors.initials: AG
authors.lastname: van der Zee
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009426:Netherlands; D065006:Papanicolaou Test; D010349:Patient Compliance; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*