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).
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.
Eijsink
J J H
JJ
Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
de Bock
G H
GH
Kuiper
J L
JL
Reesink-Peters
N
N
van Hemel
B M
BM
Hollema
H
H
Nijman
H W
HW
Mourits
M J E
MJ
van der Zee
A G J
AG
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*