Predictors of Absent High-grade Cervical Intraepithelial Neoplasia (CIN) in Loop Electrosurgical Excision Procedure Specimens of Patients with Colposcopic Directed Biopsy-Confirmed High-Grade CIN

Yenrudee Poomtavorn,Araya Sammor,Komsun Suwannarurk,Yuthadej Thaweekul,Chamnan Tanprasertkul

doi:10.31557/apjcp.2019.20.3.849

Abstract

Objective:To determine predictors of having cervical intraepithelial neoplasia (CIN) 1 or less in loop electrosurgical excision procedure (LEEP) specimens of patients with colposcopic directed biopsy-confirmed CIN 2-3.Methods:Two hundred and eighty patients with colposcopic directed biopsy-confirmed CIN 2-3 who subsequently underwent LEEP were enrolled in the retrospective study. Related clinical data were collected to determine the predictors of CIN 1 or less in LEEP specimens.Results:CIN 1 or less in LEEP specimens was found in 71 (25.4%) of 280 patients. Multivariate logistic regression analyses demonstrated that nulliparity [OR (95% CI) = 3.375 (1.245-9.150)], low grade Papanicolaou (Pap) results [OR (95% CI) = 6.410 (2.877-14.280)] and low grade colposcopic impression [OR (95% CI) = 16.506 (5.844-46.632)] were significant risk factors of having CIN 1 or less in LEEP specimens. Neither persistent nor recurrent CIN 2-3 was detected in 71 patients who had CIN 1 or less in LEEP specimens. However, persistent or recurrent CIN 2-3 developed in 3 out of 209 (1.4%) patients with CIN 2-3 found in LEEP specimens.Conclusion:Approximately 25% of patients with CIN 2-3 in colposcopic directed biopsy specimens had CIN 1 or less found in LEEP specimens. Predicting factors of having CIN 1 or less in LEEP specimens were nulliparity, low grade Pap results and low grade colposcopic impression.

Highlights

Detection and treatment of high grade cervical intraepithelial neoplasia (CIN 2-3) is known to prevent the development of cervical cancer (Pinto and Crum, 2000; Massad et al, 2013)
Values are presented as N (%); ASC-US, atypical squamous cells of undetermined significance; LSIL, low grade squamous intraepithelial lesions; HSIL, high grade squamous intraepithelial lesions; ASC-H, atypical squamous cells cannot exclude HSIL; AGC, atypical glandular cells; CIN, cervical intraepithelial neoplasia; AIS, adenocarcinoma in situ; LEEP, loop electrosurgical excision procedure
Values are presented as N (%); aLow grade Papanicolaou test, atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesions (LSIL); bHigh grade Papanicolaou test, high grade squamous intraepithelial lesions (HSIL); atypical squamous cells cannot exclude HSIL (ASC-H); atypical glandular cells (AGC) and cancer; CIN, cervical intraepithelial neoplasia

Summary

Introduction

Detection and treatment of high grade cervical intraepithelial neoplasia (CIN 2-3) is known to prevent the development of cervical cancer (Pinto and Crum, 2000; Massad et al, 2013). Pathological findings of LEEP specimens are often correlated with the results of colposcopic directed biopsy-confirmed CIN 2-3. Some LEEP specimens of patients with colposcopic directed biopsy-confirmed CIN 2-3 reveal only CIN 1 or less. Previous studies have reported that there were 14-24% of patients with colposcopic directed biopsy-confirmed CIN 2-3 had CIN 1 or less in LEEP specimens (Ryu et al, 2010; Witt et al, 2012; Rodriguez-Manfredi et al, 2013; Giannella et al, 2015; Nam et al, 2015; Zhang et al, 2015). LEEP is a safe excision procedure, it may carry complications, including bleeding, infection, incompetent cervix and cervical stenosis. These complications may result in an increased risk of future pregnancy problems. Yenrudee Poomtavorn et al women with colposcopic directed biopsy-confirmed CIN 2-3 and to evaluate the predicting factors of having CIN 1 or less in these LEEP specimens

Materials and Methods

Results

Discussion