Predictors of recurrence in high-grade cervical lesions and a plan of management.
PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended.


OBJECTIVE
To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up.


METHODS
prospective pilot study.


METHODS
Gynaecological surgical center.


METHODS
Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions.


METHODS
According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment.


METHODS
underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up.


RESULTS
Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment.


CONCLUSIONS
In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.
Leguevaque
P
P
Department of General and Gynecological Surgery, CHU Rangueil, Toulouse, France.
Motton
S
S
Decharme
A
A
Soulé-Tholy
M
M
Escourrou
G
G
Hoff
J
J
D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus; D003127:Colposcopy; D019092:Conization; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D017211:Treatment Failure; D014412:Tumor Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000628:therapy