The Clinical Significance of High Risk HPV Infection and Positive Margin of LEEP in the Management of CIN III

Ko, Joon Sung; Nam, Joo Hyun

Abstract

OBJECTIVE
To determine the significance of high risk human papilloma virus (HPV) infection and involvement of the resection margins of cervical cone biopsy specimens removed by loop electrosurgical excision procedure (LEEP) in the management of cervical intraepithelial neoplasia (CIN III).
METHODS
Records of 506 LEEP procedures performed due to abnormal Pap result between December 1995 and December 1998 were reviewed. Among them, 232 cases with histologically proven as CIN III in LEEP and follow-up Pap smear more than 6 months was available were assessed. All patients were assigned according to HPV infection and resection margin involvement in LEEP, and recurrence rate in the follow-up was compared with reference to post-LEEP treatment regimen, observation or hysterectomy in each group. RESULTS: Of 232 cases reviewed, 10 cases(4.3%) were ASCUS, 19 cases(8.2%) were LSIL, 199 cases(85.8%) were HSIL, and 4 cases(1.7%) were invasive cancer in initial Pap smear. Abnormal Pap result in the follow-up was as follows: 4 cases of ASCUS, no case of LSIL, and 6 cases of HSIL. Excluding ASCUS, the overall recurrence rate in the follow-up was 2.6%(6/232). HPV positive was 164(70.7%) and HPV negative was 68(29.3%) in the LEEP specimen. Of 164 HPV positive, 41 were followed up without further treatment and 123 with hysterectomy. There was no significant difference in the recurrence rate between the two groups(P=0.41). Of 68 HPV negative, 27 were only followed up and in 41, hysterectomy was done. And also, there was no significant difference(P=0.32). Of 232 cases, resection margin was positive in 167(72.0%) and negative in 65(28.0%). Of 65 margin negative, 29 were followed up without further treatment and 36 with hysterectomy. There was no significant difference in the recurrence rate between the two groups(P=0.36). Among 167 margin positive, 39 were only followed up and in 128 hysterectomy was done. Recurrence rate was significantly higher in followed up only group(P=0.04).
CONCLUSION
HPV infection in LEEP specimen was not helpful in deciding post LEEP treatment modality in CIN III patient. But, when resection margin was positive, hysterectomy should be performed because by doing so, recurrence rate was significantly lower than when only follow up was done.