title: Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome.
abstract: OBJECTIVE
  Recent meta-analyses have shown that loop treatment of the cervix of > 10 mm depth may be associated with adverse outcomes in future pregnancies. The aim of this study is to assess the rate of incomplete excision and recurrent disease in relation to depth of excision in women of reproductive age undergoing loop treatment.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Colposcopy Clinic, Northern Gynaecological Oncology Centre, Gateshead, UK.
  
  
  METHODS
  In all, 1558 women undergoing loop treatment for high-grade cervical intraepithelial neoplasia (HGCIN) between 1998 and 2003.
  
  
  METHODS
  Women were followed up until 2008. Recurrence was analysed using Kaplan-Meier plots.
  
  
  METHODS
  Incomplete excision rates and recurrence rates. Recurrence was defined as post-treatment disease with high-grade histology. Any dyskaryotic cytology on follow-up was also documented.
  
  
  RESULTS
  Recurrent high-grade disease on histology was found in 57/1558 (3.7%) women. In women ≤ 35 years old, despite a greater rate of incomplete excision at the endocervical margin at loop depths < 10 mm compared with ≥ 10 mm (24.4% versus 13.3%, P < 0.01), the recurrence rate was similar between the two groups (4.3% versus 3.4%, log-rank, P = 0.52). In contrast, a loop depth < 10 mm was associated with a higher disease recurrence rate (7.5% versus 3.0%, log-rank, P = 0.05) in women > 35 years.
  
  
  CONCLUSIONS
  In women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for < 10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies.
authors.affiliation: Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ang
authors.forename: A
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: C
authors.initials: C
authors.lastname: Burnley
authors.forename: K
authors.initials: K
authors.lastname: Faulkner
authors.forename: Pa
authors.initials: P
authors.lastname: Cross
authors.forename: P
authors.initials: P
authors.lastname: Martin-Hirsch
authors.forename: R
authors.initials: R
authors.lastname: Naik
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery*; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*