Abstract
ObjectiveThis study was performed to evaluate the significance of positive resection margins (RMs) with the loop electrosurgical excision procedure combined with cold coagulation (LEEP with CC) as a definitive treatment for patients with cervical intraepithelial neoplasia (CIN) and adenocarcinoma in-situ.MethodsWe retrospectively reviewed 467 patients who underwent LEEP with CC. A right-angled triangular loop in a single pass followed by a CC (120 °C) to the cone bed for 10 to 20 s was used. Pathology reports and clinical data were obtained and evaluated.ResultsHistopathology evaluation of LEEP tissue samples revealed the presence of CIN 1 in 69, CIN 2/3 in 366, AIS in 5 and invasive carcinoma in 16 (microinvasive squamous cell carcinoma (SCC) and invasive SCC, 13 and 3) patients. Margins were positive in 66 (14.5%) cases: 0 in CIN 1, 54 in CIN 2/3 (12.4%), 1 in AIS (20.0%) and 11 in microinvasive/invasive SCC (68.8%). Although 54 CIN2/3 patients with positive RMs did not undergo additional treatment, 1 of these (1.9%) was confirmed to have residual CIN3 at the first follow-up. Two of 8 (25.0%) microinvasive SCC patients with positive RMs were confirmed to have residual diseases (1 microinvasive SCC and 1 invasive SCC) after hysterectomy. Four out of 360 (1 positive RM, 3 negative RM) CIN cases recurred during the study period.ConclusionsThese results suggest that CIN patients with positive RMs after LEEP with CC may be followed up without additional treatment.
Highlights
Cervical intraepithelial neoplasia (CIN) has been treated in many different ways including various ablative and excisional procedures [1]
Several earlier studies have reported that replicate surgical specimens of patients with involved resection margins (RMs) frequently have no residual neoplasia [14,15,16,17], the margin status of conization specimens is considered to be an important predictor of residual neoplasia [18, 19]
After loop electrosurgical excision procedure (LEEP), 19 of 98 (19.4%) CIN1 cases were upgraded to CIN2/3 according to the pathology report
Summary
Clinical data During the study period, 456 patients underwent LEEP using a right-angled triangular loop with CC. Forty of 89 (44.9%) CIN2 cases were upgraded according to the pathology report as follows: 38 to CIN3 and 1 each to AIS and to microinvasive SCC. All patients who were diagnosed postoperatively as having AIS, microinvasive SCC or invasive SCC were followed up at regular intervals for a median period of 48 months (range, 4 to 157 months) (Table 1). One microinvasive SCC case with positive RMs (endocervix and exocervix) was followed up without additional surgical treatment. This patient has shown ‘no evidence of disease’ for 46 months. Five negative RM microinvasive SCC cases (3 underwent hysterectomy, 2 without additional surgical treatment) had no residual disease during the study period. AIS, microinvasive SCC and invasive SCC cases showed no recurrent disease during the follow-up period
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