Richard Hopley, M.D. | 10/08/2019While all patients should be followed up equally after a LEEP, additional factors may be considered to evaluate the likelihood HSIL/CIN 2+ persistence and recurrence.
Regardless of the presence of residual HSIL/CIN 2+ within the excision specimen, the ideal testing plan for patients would include a follow up six months after the initial test. Providers may also be able to consider other factors in identifying patients more likely to experience persistence and/or recurrence of disease.
HSIL/CIN 2+ Recurrence Risk Factors
One publication1 studied these risk factors. In it 619 women were followed up after a LEEP excision over a period of 5 to 50 months, 65% of which were biopsied in this period. Of these women, 25% had persistent or recurrent disease on follow up biopsy. When present, the following factors indicated to a greater likelihood of recurrence:
- HIV positivity
- Dysplasia in the preoperative ECC
- Positive LEEP margins
Other studies2,3 reported similar findings to the above, but also:
- Persistent HPV infection after LEEP procedure
- Positive LEEP margins (particularly the endocervical margin.)
Follow up cervical cytology should be performed six months after the LEEP (with concurrent HPV testing). Persistent HPV infection may be viewed as a negative prognostic factor (and conversely, a positive one if the HPV status is negative at this point.) Since no single reassuring variable can foretells a favorable clinical course, close follow up is recommended in all patients. This path can provide the patient additional reassurance and ensure the provider’s ability to tend appropriately to any unforeseen recurrences.
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Bibliography
- 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.
- Can a More Detailed Evaluation of Excision Margins Refine Cytologic Follow-up fo Women Post-LLETZ for High Grade Dysplasia? Treacy, A. s.l. : International Journal of Gynecologic Pathology, 2010, Vol. 29.
- Early human papillomavirus testing predicts residual/recurrent disease after LEEP. Aeli R, et al. 4, s.l. : Journal of Gynecologic Oncology, 2005, Vol. 23.