Outcomes of Two Years Follow-Up after Loop Electrosurgical Excision Procedure in a University Hospital

Year 2020, , 156 - 161, 19.09.2020

Burak Sezgin

https://doi.org/10.5455/umj.20200624063656

Abstract

Introduction: We aimed to determine our experience on Loop electrosurgical excision procedure (LEEP) in patients with cervical preinvasive lesions in an academic hospital in two years follow-up period.
Materials and Methods: Data from 64 patients with cervical preinvasive lesion who underwent LEEP were analyzed retrospectively. Human papillomavirus (HPV) status, cytological outcomes of patients before LEEP, and after 2 years follow-up period were documented.
Results: Prior to LEEP, 94.52% of patients were positive in terms of HPV status. HPV positivity rate was detected as 13.89% after LEEP. The most common detected HPV type in residual lesions was HPV 16. 67.19% of patients who underwent LEEP have negative cytology after two years follow-up period. The other cytological outcomes at this period were as follows; 21.88% of patients had ASCUS, 9.38% of the patients had LSIL and 1.56 % of patients had HSIL cytology. Surgical margin status was positive in 6.25% of LEEP specimens. There were 3 patients who underwent re-LEEP in two years follow-up period for HSIL.
Conclusion: The LEEP procedure was applied to patients with HSIL and ASC-H with satisfactory recurrence rates in two years follow-up period.

Keywords

Leep, HSIL, HPV, LSIL, Cervical cancer

References

• Rositch AF, Soeters HM, Offutt-Powell TN, Wheeler BS, Taylor SM, Smith JS. The incidence of human papillomavirus infection following treatment for cervical neoplasia: a systematic review. Gynecol Oncol. 2014;132:767-779
• Hoffman SR, Le T, Lockhart A, Sanusi A, Dal Santo L, Davis M, et al. Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review. Int J Cancer. 2017;141:8-23
• Chelmow D. Committee on Practice Bulletins-Gynecology. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol. 2016;128:e111-e130
• Santesso N, Mustafa RA, Wiercioch W, Kehar R, Gandhi S, Chen Y, et al. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. Int J Gynecol Obstet. 2016;132:266–71
• Chen LM, Liu L, Tao X, He Y, Guo LP, Zhang HW, et al. Analysis of recurrence and its influencing factors in patients with cervical HSIL within 24 months after LEEP. Zhonghua Fu Chan Ke Za Zhi. 2019;54:534–40
• Duesing N, Schwarz J, Choschzick M, Jaenicke F, Gieseking F, Issa R, et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012;286:1549–54
• Cecchini S, Visioli CB, Zappa M, Ciatto S. Recurrence after treatment by loop electrosurgical excision procedure (LEEP) of high-grade cervical intraepithelial neoplasia. Tumori. 2002;88:478-480
• Fan Q, Tay SK, Shen K. Loop electrosurgical excision procedure: a valuable method for the treatment of cervical intraepithelial neoplasia. Zhonghua Fu Chan Ke Za Zhi. 2001;36:271-4
• Alonso I, Torné A, Puig-Tintoré LM, Esteve R, Quinto L, Campo E, et al. Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3. Gynecol Oncol. 2006;103:631–6
• Papalia N, Rohla A, Tang S, Nation J, Nelson G. Defining the short-term disease recurrence after loop electrosurgical excision procedure (LEEP). BMC Womens Health. 2020; 20(1): 34
• Young TK, Lee JM, Hur SY, Cho CH, Kim YT, Seung CK, et al. Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia. Int J Cancer. 2010;126:1903–9
• Jing L, Dan W, Zhunan L, Ying X, Yi C. Residual lesions in uterine specimens after loop electrosurgical excision procedure in patients with CIN. Arch Gynecol Obstet 2018; 298:805–12.
• Bae JH, Kim CJ, Park TC, Namkoong SE, Park JS. Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure. Int J Gynecol Cancer 2007;17:1271–7
• Gallwas J, Ditsch N, Hillemanns P, Friese K, Thaler C, Dannecker C. The significance of HPV in the follow-up period after treatment for CIN. Eur J Gynaecol Oncol. 2010;31:27-30
• Bornstein J, Schwartz J, Perri A, Harroch J, Zarfati D. Tools for post LEEP surveillance. Obstet Gynecol Surv. 2004;59:663-8
• Shafi MI, Dunn JA, Buxton EJ, Finn CB, Jordan JA, Luesley DM. Abnormal cervical cytology following large loop excision of the transformation zone: a case controlled study. Br J Obstet Gynaecol. 1993;100:145-148
• Bornstein J, Yaakov Z, Pascal B, Faktor J, Baram A, Zarfati D, et al. Decision-making in the colposcopy clinic - A critical analysis. Eur J Obstet Gynecol Reprod Biol. 1999;85:219–24
• Bruno MT, Cassaro N, Garofalo S, Boemi S. HPV16 persistent infection and recurrent disease after LEEP. Virol J. 2019;16:148.