title: Predictive factors for residual disease in the uterine cervix after large loop excision of the transformation zone in patients with cervical intraepithelial neoplasia III.
abstract: OBJECTIVE
  To determine predictive factors for residual disease in uterine cervix after large loop excision of the transformation zone (LLETZ) in patients with cervical intraepithelial neoplasia III (CIN III).
  
  
  METHODS
  Medical records of patients who underwent LLETZ with CIN III between September 1, 1992 and December 31, 2001 in Ramathibodi Hospital were reviewed. Demographic data, colposcopic findings, and pathologic parameters were analyzed to identify the predictive factors for residual disease in uterine cervix.
  
  
  RESULTS
  The total of 541 cases were enrolled in this study. Managements after LLETZ are 1) repeated LLETZ, 2) hysterectomy, and 3) Papanicolaou smear. Residual disease was detected in a total of 156 patients (28.84%), there were 21 cases of CIN I (13.46%), 22 cases of CIN II (14.10%), 107 cases of CIN III (68.59%), and 6 (3.85%) cases of microinvasive squamous cell carcinoma of cervix. 1) Age > or = 50 years old was significant factor associated with residual disease. The incidence of residual disease was 50.00%. 2) Unsatisfactory colposcopy was significant factor associated with residual disease with 38.44% incidence of residual disease. 3) Margins involvement of LLETZ specimen was the only pathological predictive factor identified. The incidence of residual disease with clear margin, endocervical margin, ectocervical margin, and both margins involvement were 14.74, 52.63, 57.14, and 74.19% respectively. Other parameters, including gravidity, parity, menopausal status, cervical gland involvement, and number of quadrants involvement were not predictive of residual disease.
  
  
  CONCLUSIONS
  1) Age > or = 50 years old, 2) unsatisfactory colposcopy, and 3) margins involvement of LLETZ specimens were the predictive factors for residual disease in uterine cervix.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand. hamontri_s@yahoo.com
authors.forename: Suttha
authors.initials: S
authors.lastname: Hamontri
authors.forename: Nathapong
authors.initials: N
authors.lastname: Israngura
authors.forename: Mana
authors.initials: M
authors.lastname: Rochanawutanon
authors.forename: Sunchai
authors.initials: S
authors.lastname: Bullangpoti
authors.forename: Somsak
authors.initials: S
authors.lastname: Tangtrakul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D015994:Incidence; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology* / Q000601:surgery; D065006:Papanicolaou Test; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*