title: Treatment failure following excision therapy of CIN: the impact of direct colposcopic vision during procedure.
abstract: OBJECTIVE
  To assess whether the use of direct colposcopic vision during excision therapy of cervical intraepithelial neoplasia (CIN) has an impact on the risk of treatment failure.
  
  
  METHODS
  Data from 285 patients who had had excision therapy with proven CIN at specimen histological analysis were reviewed. Primary endpoint was the occurrence of post-treatment failure defined by the histological diagnosis of CIN 2-3 during follow-up. Data were analysed according to the use of colposcopy at the time of initial therapy of CIN.
  
  
  RESULTS
  The use of direct colposcopic vision (DCV) resulted in a significant reduction in the mean height (p = 0.008) and diameter (p < 0.001) of the excised specimen. Patients' median follow-up was 28.4 (±1.3) months. A total of 43 (15.2 %) patients were diagnosed with treatment failure. Compared to excisions performed without any use of colposcopy, DCV was not found to have any significant impact on the risk of treatment failure (HR: 0.58; 95 % CI 0.16-2.13, p = 0.412), neither when compared to excisions performed immediately after colposcopy (HR: 0.91; 95 % CI 0.47-1.79; p = 0.794). The only factors found to have a significant impact on the risk of treatment failure was the identification of clear margins (HR: 0.36; 95 %CI 0.19-0.69; p = 0.002) and the diameter of the surgical specimen (HR: 0.94; 95 %CI 0.89-0.99; p = 0.040).
  
  
  CONCLUSIONS
  Although the use of DCV during excision therapy of CIN was associated with a significant reduction in the dimensions of the excised cervical specimen, it did not result in a significant change in the risk of treatment failure.
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (APHM), Aix-Marseille Université (AMU), Chemin des Bourrely, 13015, Marseille, France.
authors.forename: Mellie
authors.initials: M
authors.lastname: Heineman
authors.affiliation: Aix-Marseille Université, Inserm, IRD, UMR S912, SESSTIM, 13385, Marseille, France.|Public Health Department, APHM, Hôpital de la Timone, BioSTIC, 13385, Marseille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Department of Pathology, Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Marseille, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Villeret
authors.affiliation: Aix-Marseille Université, Inserm, IRD, UMR S912, SESSTIM, 13385, Marseille, France.|Department of Obstetrics and Gynaecology, Hôpital La Conception, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université (AMU), Marseille, France.
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
authors.affiliation: Aix-Marseille Université, Inserm, IRD, UMR S912, SESSTIM, 13385, Marseille, France.|Department of Gynecologic Oncology Surgery, Institut Paoli Calmettes (IPC), Aix-Marseille Université (AMU), Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (APHM), Aix-Marseille Université (AMU), Chemin des Bourrely, 13015, Marseille, France.|Aix-Marseille Université, Inserm, IRD, UMR S912, SESSTIM, 13385, Marseille, France.
authors.forename: Léon
authors.initials: L
authors.lastname: Boubli
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille (APHM), Aix-Marseille Université (AMU), Chemin des Bourrely, 13015, Marseille, France. xcarco@free.fr.|Aix-Marseille Université, Inserm, IRD, UMR S912, SESSTIM, 13385, Marseille, France. xcarco@free.fr.|Laboratory of Biogenotoxicology, IMBE, CNRS, IRD, Université Avignon, Avignon, France. xcarco@free.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Carcopino
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012306:Risk; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*
keywords: Cervical intraepithelial neoplasia; Colposcopy; Excision; Surgical specimen; Treatment failure