Predictive factors for residual neoplasia after loop electrosurgical excisional procedure (LEEP) in the treatment of cervical intraepithelial neoplasia

Im, Tai Gun; Hwang, Ho Myong; Jeong, Young Ju; Oh, Byung Chan

Abstract

OBJECTIVE
The optimal management of cervical intraepithelial neoplasia (CIN) after loop electrosurgical excisional procedure (LEEP) remains controversial and reliable predictive factors of residual disease after LEEP have not been consistently identified. This study was performed to identify predictive factors for residual disease after LEEP in patients with CIN.
METHODS
From June 1996 to May 2000, 166 patients who received subsequent hysterectomy after LEEP according to indication in Dept. of Obstet. and Gynecol. at Chonbuk National University Hospital. The age of patients, the severity of disease, the status of resection margin, and high-risk HPV infection were analyzed for predictive values of residual disease. The student t-test and chi-square test were used for statistical analysis.
RESULTS
1. The residual disease after hysterectomy was negative in 68.1% (113/166) and positive in 31.9% (53/166). 2. The mean age of patients with no residual disease was 45.7 years (range;27-67) and that of patients with residual disease was 49.7 years (range;32-67), showing significant difference (p=0.008). 3. Thirty-three out of 129 cases (25.6%) with negative resection margin and 20 out of 37 cases (54.1%) with positive resection margin in LEEP had residual disease, showing significant difference (p=0.001). 4. Residual disease after hysterectomy was more frequent in patients with more high grade lesions in LEEP, but there was no statistical significant difference (p>0.05). 5. There was no significant difference in the possibility of positive residual disease after hysterectomy between HPV-positive group and HPV-negative group (p=0.84).
CONCLUSION
The negative resection margin in LEEP does not always guarantee that there is no residual disease. More aggressive treatment plan (wide conization or hysterectomy) should be considered in patients who has higher possibility of residual disease such as old age and positive resection margin in LEEP.