We have just described how all patients should be followed up equally after a LEEP, regardless of the presence of squamous dysplasia within the excision specimen. However, are there other factors which might identify patients who are more likely to experience persistence/recurrence of disease? One study attempted to identify such risk factors.1 619 women were followed up (for 5-50 months) after a LEEP procedure, most of which were subsequently biopsied (65%). Of these women, 25% had persistent or recurrent disease. Factors influencing recurrence included the following:

  • HIV positivity
  • A preoperative ECC which was positive for dysplasia
  • Positive margin status in the excision specimen

Other studies 23 reported similar findings, as well as:

  • Persistent HPV infection after LEEP procedure
  • Positive margin status in the excision specimen (particularly the endocervical margin)

Some of these factors are useful as they may be used to counsel patients about the importance of follow-up prior to the excision procedure (i.e. preoperative ECC positivity, HIV seropositivity.) It should be noted that some studies also report high grade pathology within the cervical excision specimen as an additional risk factor for increased likelihood of recurrence/persistence of disease (in contradiction to the accompanying article within this issue). However, despite this, the overall message is clear; there is no single reassuring variable which portends a favorable clinical course, and close follow up is recommended in all patients.

Image of the cervical transformation zone showing replacement of the normal epithelium by high grade dysplasia.

BIBLIOGRAPHY: 1 Factors Influencing Persistence or Recurrence of Cervical Intraepithelial Neoplasia After Loop Electrosurgical Excision Procedure. Malapati R, et al. 3, s.l. : Journal of Lower Genital Tract Disease, 2011, Vol. 15. 2 Can a More Detailed Evaluation of Excision Margins Refine Cytologic Follow-up of Women Post-LLETZ for High Grade Dysplasia? Treacy, A. s.l. : International Journal of Gynecologic Pathology, 2010, Vol. 29. 3 Early human papillomavirus testing predicts residual/recurrent disease after LEEP. Aeli R, et al. 4, s.l. : Journal of Gynecologic Oncology, 2005, Vol. 23. Article written by PathAdvantage pathologist Richard Hopley, MD.