title: Factors associated with the persistence/recurrence of CIN2/3 in women submitted to loop electrosurgical excision procedure in a teaching hospital in northeastern Brazil: a case-control study.
abstract: OBJECTIVE
  This study aimed to identify risk factors associated with the persistence/recurrence of cervical intraepithelial neoplasia (CIN) 2/3 in women submitted to loop electrosurgical excision procedure (LEEP) in a hospital in northeastern Brazil.
  
  
  METHODS
  A case-control study included 50 women with and 50 women without persistence/recurrence of CIN2/3 after LEEP at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between 2004 and 2011. Data were collected from June to December 2011. Inclusion criteria were diagnosis of CIN2/3 during follow-up (cases) and women free of CIN2/3 after a follow-up of 2 years or longer (controls). Exclusion criteria (cases/controls) were LEEP performed at another hospital, LEEP performed for persistent CIN1, invasive carcinoma in the cone specimen or at cytology, and/or histopathology within a 2-year follow-up period. Persistence was defined as residual disease detected in the first year after LEEP, and recurrence was defined as the reappearance of a lesion more than 1 year after surgery. Bivariate analysis was performed for biological, sociodemographic, sexual, reproductive, lifestyle, and clinical variables. Odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated, and a multiple logistic regression analysis was performed to control for potential confounding factors. The study was approved by IMIP's internal review board.
  
  
  RESULTS
  Multiple logistic regression analysis showed a significant association between persistence/recurrence of CIN2/3 and living outside the capital city (OR=3.11, 95% CI=1.14-8.41), smoking (OR=4.22, 95% CI=1.18-15.05), and positive endocervical margins (OR=6.58, 95% CI=2.37-18.28).
  
  
  CONCLUSIONS
  Women with persistence/recurrence of CIN2/3 are more likely to live outside the state capital, be smokers, and have positive endocervical margins, so these women should be followed up more closely.
authors.affiliation: 1Federal University of the Vale do São Francisco (UNIVASE), Petrolina; 2Maternal and Child Healthcare and 3Lower Genital Tract Pathology Outpatient Clinic, Instituto de Medicina Integral Prof. Fernando Figueira, Recife; 4Federal University of Pernambuco; and 5Pathology Department, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil.
authors.forename: Marília Vieira
authors.initials: MV
authors.lastname: de Mello Silva
authors.forename: Isabela Cristina
authors.initials: IC
authors.lastname: Coutinho
authors.forename: Sandra
authors.initials: S
authors.lastname: de Andrade Heráclio
authors.forename: Horácio M
authors.initials: HM
authors.lastname: Fittipaldi
authors.forename: Leila
authors.initials: L
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D016022:Case-Control Studies; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000601:surgery*