Residual and recurrent disease rates following LEEP treatment in high-grade cervical intraepithelial lesions.
BACKGROUND
Loop electrosurgical excision procedure (LEEP) is a basic procedure in the conization performed on patients with CIN II/III. After excisional therapy, close follow up is essential for the earlier detection of residual and recurrent disease. The value of PAP-smear and HPV-DNA tests for investigation of residual and recurrent disease in patients diagnosed with high-grade intraepithelial lesion after LEEP treatment was purposed.


METHODS
42 patients were included in the study for whom epithelial cell anomalies were detected at PAP-smear screening. HPV-DNA test, colposcopy, cervical biopsy and endocervical curettage and then LEEP procedures were performed. The patients were followed with HPV DNA and PAP-smear tests in terms of recurrence and residual disease at 3-month intervals.


RESULTS
HPV-DNA examination revealed that 36 patients (85.7%) were positive for high-risk HPV-DNA before treatment. Histopathological evaluation of LEEP materials revealed the presence of CIN I in 4 and CIN II/III in 38 patients. Surgical margin was positive in five patients. No sign of invasive cervical neoplasia was detected. The high-risk HPV DNA's persistence was observed in 11 (30.6%) of the 36 patients of whom HPV-DNA positivity had been detected before the treatment. HSIL was detected in four patients using PAP-smear on the third month examination. Positive LEEP surgical margins were found to be positively correlated both with HPV-DNA positivity detected during the follow-up examination and with the presence of residual disease in the follow-up PAP smear.


CONCLUSIONS
LEEP is a basic procedure in the conization performed on patients with CIN II/III. In spite of high recurrence and residual disease rates, this kind of patients requires close monitoring. Follow-up with HPV and PAP-smear tests after LEEP treatment is of great importance in the detection of residual or recurrent disease.
Baloglu
Ali
A
1st Department of Obstetrics and Gynecology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey. alibaloglu@yahoo.com
Uysal
Dilek
D
Bezircioglu
Incim
I
Bicer
Merve
M
Inci
Ayşegul
A
D000328:Adult; D001706:Biopsy; D004279:DNA, Viral / Q000032:analysis*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery / Q000821:virology; D018365:Neoplasm, Residual / Q000473:pathology / Q000821:virology; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology
D004279:DNA, Viral