title: High-Grade Cervical Dysplasia After Negative Loop Electrosurgical Excision Procedure.
abstract: OBJECTIVE
  To describe the prevalence and correlates of high-grade cervical intraepithelial neoplasia (CIN2+) after a negative loop electrosurgical excision procedure (LEEP), performed for high-grade squamous intraepithelial lesion (HSIL) cervical cytology.
  
  
  METHODS
  One hundred six women from our university-based colposcopy clinic underwent LEEP between 2007 and 2014. Negative LEEP was defined as CIN1 or less. Persistence/recurrence estimates were calculated by treatment (see-and-treat vs 3-step conventional strategy-cervical cytology, colposcopic biopsy, LEEP) and LEEP results (negative vs positive) using the Kaplan-Meier method. Predictors of CIN2+ after a negative LEEP were examined by multivariate Cox proportional hazards model.
  
  
  RESULTS
  Overall, the prevalence of CIN2+ after a negative LEEP for HSIL was 14%. Persistence/recurrence of CIN2+ was similar between women with a negative and positive see-and-treat LEEP (25% vs 15%) and those with a negative or positive 3-step conventional LEEP (7% vs 22%) (log-rank, P = 0.58). Positive LEEP margin was more common among women with a positive LEEP (53.7% see-and-treat vs 42.6% conventional) compared with a negative result (0% see-and-treat vs 3.7% conventional, P < 0.0001). The risk of CIN2+ after a negative LEEP did not differ by management strategy (log-rank, P = 0.85) or LEEP result (log-rank, P = 0.58). In multivariate analysis, correlates of persistent/recurrent CIN2+ included older age (adjusted odds ratio [aOR], 1.09; P = 0.0003), history of previous LEEP (aOR, 8.99; P < 0.0001), and positive LEEP margin (aOR, 13.56; P = 0.0005).
  
  
  CONCLUSIONS
  A negative LEEP does not allow less stringent surveillance, as CIN2+ risk is similar to that after CIN2+ is found in the LEEP specimen, whether the specimen was obtained by see-and-treat or conventional 3-step approach.
authors: 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Alvin J. Siteman Cancer Center; and 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine. St. Louis, MO.
authors: Lindsay M
authors: LM
authors: Kuroki
authors: Laura
authors: L
authors: James-Nywening
authors: Ningying
authors: N
authors: Wu
authors: Jingxia
authors: J
authors: Liu
authors: Matthew A
authors: MA
authors: Powell
authors: Premal H
authors: PH
authors: Thaker
authors: L Stewart
authors: LS
authors: Massad
mesh_terms: D000328:Adult; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*