Does the trend toward less deep excisions in LLETZ to minimize obstetric risk lead to less favorable oncological outcomes?

Abstract

To analyze the relationship between large loop excision of the transformation zone (LLETZ) depth and the persistence of disease and human papillomavirus (HPV) infection in patients with cervical intraepithelial neoplasia grades 2 and 3. A cross-sectional observational retrospective study included women with cervical intraepithelial neoplasia grades 2 and 3 who underwent LLETZ at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 1, 2011, to December 31, 2016. Follow-up of cytology and HPV detection were performed at 6 and 12-18months after surgery. In this study of 256 women, multivariate analysis revealed that conization depth of 10mm or less did not indicate an increase of persistence/recurrence of pathological cytology at 6months (P=0.094) and after 12-18months (P=0.234), or infection by HPV at 6months (P=0.675) and 12-18months (P=0.938) after LLETZ. The affected endocervical margin at 6months is the sole independent risk factor for persistence, both in the lesion (P=0.003) and HPV (P=0.004). Conization depth lower than 10mm at LLETZ did not increase disease persistence or infection by HPV in an 18month monitoring period. Therefore, higher depth conizations would not be justified to ensure favorable oncological results.