title: Does LLETZ excision margin status predict residual disease in women who have undergone post-treatment cervical cytology and high-risk human papillomavirus testing?
abstract: OBJECTIVE
  This study looks at the importance of large loop excision of the transformation zone (LLETZ) excision margins and residual cervical intraepithelial neoplasia (CIN) in women undertaking high-risk human papillomavirus (hrHPV) test of cure (TOC).
  
  
  METHODS
  A retrospective cohort study with interval analysis performed June 2007 and June 2012 on all women undertaking treatment for CIN and subsequent hrHPV TOC 6 months post LLETZ.
  
  
  RESULTS
  Final analysis group comprised 2093 women treated by LLETZ (1396 completely excised; 697 incompletely excised). 298 out of 1794 women (13%) were hrHPV positive at TOC. Thirty-six women who failed TOC and attended colposcopy had residual CIN. No statistically significant difference existed between the completely and incompletely excised groups with regards to the detection of residual CIN at 6 months post-treatment. There was no correlation of margins of excision with hrHPV status at TOC. The overall cure rate at TOC was 98%.
  
  
  CONCLUSIONS
  TOC pathways recommend subsequent follow-up in primary care. This study identified no safety issues with TOC pathways. We can no longer assess histological failure rates at 12 months; we, therefore, recommend that this measure of treatment failure be redefined for post TOC women. It seems time to question the benefits of routine excision margins reporting, in the absence of invasion, for treated CIN. Future reporting needs to be reconsidered by the Royal College of Pathologists.
authors.affiliation: Department of Gynaecological Oncology/Jessop Wing Colposcopy Unit, Sheffield Hospitals NHS Trust, Sheffield, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Palmer
authors.affiliation: Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ravenscroft
authors.affiliation: Department of Cytology, Sheffield Hospitals NHS Trust, Sheffield, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ellis
authors.affiliation: Department of Cytology, Sheffield Hospitals NHS Trust, Sheffield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Crossley
authors.affiliation: Department of Cytology, Sheffield Hospitals NHS Trust, Sheffield, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dudding
authors.affiliation: Department of Cytology, Sheffield Hospitals NHS Trust, Sheffield, UK.|Department of Histopathology & Cytology, Sheffield Hospitals NHS Trust, Sheffield, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Smith
authors.affiliation: Department of Gynaecological Oncology/Jessop Wing Colposcopy Unit, Sheffield Hospitals NHS Trust, Sheffield, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Tidy
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003127:Colposcopy; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
keywords: HPV; LLETZ; colposcopy; margins of excision