Citation Information :
Pambinkavil R, Thomas A, Thomas DS, Thomas V, Chandy RG, Daniel S, Peedicayil A, Sebastian A. Factors Predicting Recurrence of Cervical Intraepithelial Neoplasia after Excisional Procedure-A 10-year Experience from A Tertiary Care Center. J South Asian Feder Obs Gynae 2023; 15 (4):404-408.
Aim: Cervical intraepithelial neoplasia (CIN) is a precancerous condition of the uterine cervix commonly encountered in clinical practice. Treatment of CIN is excisional or ablative. This study aims to elucidate and evaluate the possible risk factors commonly associated with the recurrence of CIN following an excisional procedure.
Materials and methods: This was a retrospective study conducted between 2010 and 2019. Patients who underwent excisional procedures for CIN2/3 were included. The information was collected from the hospital database. Clinical and sociodemographic data, recurrence characteristics, and follow-up data were analyzed.
Results: Recurrent lesions were noted in 26 (15.4%) patients. The pattern of recurrence was CIN in 13 patients (50%), vaginal intraepithelial neoplasia (VAIN) in 11 (42.3%), and cervical cancer in 2 (7.7%) patients. The median follow-up time was 8 (1–117 months). Univariate analysis showed HIV-positive women were at greater risk of recurrence (HR = 2.8, 95% CI = 0.93–8.5; p = 0.009) but advanced age, presence of involved margins, endocervical gland or crypt involvement, and high-risk HPV status post-procedure were not (p > 0.1) associated with recurrence in our study.
Conclusion: Excisional procedures are successful and patients with risk factors like HIV seropositivity and positive margins should be targeted for close surveillance or offered a hysterectomy.
Clinical significance: Following excisional procedures, patients with risk factors for recurrence should be advised of close surveillance or offered a hysterectomy.
Montz FJ. Management of high-grade cervical intraepithelial neoplasia and low-grade squamous intraepithelial lesion and potential complications. Clin Obstet Gynecol 2000;43(2):394–409. DOI: 10.1097/00003081-200006000-00018.
Tasci T, Turan T, Ureyen I, et al. Is there any predictor for residual disease after cervical conization with positive surgical margins for HSIL or microinvasive cervical cancer? J Lower Genit Tract Dis 2015;19(2):115–118. DOI: 10.1097/LGT.0000000000000079.
McCredie MRE, Sharples KJ, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol 2008;9(5):425–434. DOI: 10.1016/S1470-2045(08)70103-7.
Olaniyan OB. Validity of colposcopy in the diagnosis of early cervical neoplasia--a review. Afr J Reprod Health 2002;6(3):59–69. PMID: 12685410.
Leguevaque P, Motton S, Decharme A, et al. Predictors of recurrence in high-grade cervical lesions and a plan of management. Eur J Surg Oncol. 2010;36(11):1073–1079. DOI: 10.1016/j.ejso.2010.08.135.
Baloglu A, Uysal D, Bezircioglu I, et al. Residual and recurrent disease rates following LEEP treatment in high-grade cervical intraepithelial lesions. Arch Gynecol Obstet 2010;282(1):69–73. DOI: 10.1007/s00404-009-1298-3.
Kalliala I, Athanasiou A, Veroniki AA, et al. Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature. Ann Oncol 2020;31(2):213–227. DOI: 10.1016/j.annonc.2019.11.004.
Townsend DE. Cervical cone margins as a predictor for residual dysplasia in post-cone hysterectomy specimens. Obstet Gynecol 1994;84(5):898. PMID: 7936537.
Newton SDC, Andresa IF, Fernanda VF, Natasha SCA, Carlos AM. A review of cervical cancer precursor lesions and recurrence after treatment: What are the real risk factors? J Gynecol Oncol 2020;3(2):1029.
Kang WD, Choi HS, Kim SM. Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)? Gynecol Oncol 2013;130(2):264–268. DOI: 10.1016/j.ygyno.2013.04.050.
Mohamed-Noor K, Quinn MA, Tan J. Outcomes after cervical cold knife conization with complete and incomplete excision of abnormal epithelium: a review of 699 cases. Gynecol Oncol 1997;67(1):34–38. DOI: 10.1006/gyno.1997.4817.
Kalogirou D, Antoniou G, Karakitsos P, et al. Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease. Eur J Gynaecol Oncol 1997;18(2):113–116. PMID: 9105859.
Livasy CA, Maygarden SJ, Rajaratnam CT, et al. Predictors of recurrent dysplasia after a cervical loop electrocautery excision procedure for CIN-3: a study of margin, endocervical gland, and quadrant involvement. Mod Pathol 1999;12(3):233–238. PMID: 10102607.
Park JY, Lee SM, Yoo CW, et al. Risk factors predicting residual disease in subsequent hysterectomy following conization for cervical intraepithelial neoplasia (CIN) III and microinvasive cervical cancer. Gynecol Oncol 2007;107(1):39–44. DOI: 10.1016/j.ygyno.2007.05.014.
Arbyn M, Redman C, Verdoodt F, et al. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol 2017;18(12):1665–1679. DOI: 10.1016/S1470-2045(17)30700-3.
Lubrano A, Medina N, Benito V, et al. Follow-up after LLETZ: a study of 682 cases of CIN 2-CIN 3 in a single institution. Eur J Obstet Gynecol Reprod Biol 2012;161(1):71–74. DOI: 10.1016/j.ejogrb.2011.11.023.
Costa S, De Simone P, Venturoli S, et al. Factors predicting human papillomavirus clearance in cervical intraepithelial neoplasia lesions treated by conization. Gynecol Oncol 2003;90(2):358–365. DOI: 10.1016/s0090-8258(03)00268-3.
Lindeque BG. Management of cervical premalignant lesions. Best Pract Res Clin Obstet Gynaecol 2005;19(4):545–561. DOI: 10.1016/j.bpobgyn.2005.02.008.
Verguts J, Bronselaer B, Donders G, et al. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG 2006;113(11):1303–1307. DOI: 10.1111/j.1471-0528.2006.01063.x.
Sarian LOZ, Derchain SFM, Pitta D da R, et al. Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ). J Clin Virol 2004;31(4):270–274. DOI: 10.1016/j.jcv.2004.05.012.
Ramchandani SM, Houck KL, Hernandez E, et al. Predicting persistent/recurrent disease in the cervix after excisional biopsy. Med Gen Med 2007;9(2):24. PMID: 17955080.
Malapati R, Chaparala S, Cejtin HE. Factors influencing persistence or recurrence of cervical intraepithelial neoplasia after loop electrosurgical excision procedure. J Lower Genit Tract Dis 2011;15(3):177–179. DOI: 10.1097/LGT.0b013e3181fee61d.
Nam K, Chung S, Kim J, et al. Factors associated with HPV persistence after conization in patients with negative margins. J Gynecol Oncol 2009;20(2):91–95. DOI: 10.3802/jgo.2009.20.2.91.
Alukal AT, Rema P, Suchata S, et al. Evaluation of factors affecting margin positivity and persistent disease after leep for cervical intraepithelial neoplasia. J Obstet Gynaecol India 2021;71(4):411–416. DOI: 10.1007/s13224-021-01450-9. Epub 12 March 2021.
Papoutsis D, Rodolakis A, Antonakou A, et al. Cervical cone measurements and residual disease in LLETZ conisation for cervical intraepithelial neoplasia. In Vivo 2011;25(4):691–695. PMID: 21709016.
Kliemann LM, Silva M, Reinheimer M, et al. Minimal cold knife conization height for high-grade cervical squamous intraepithelial lesion treatment. Eur J Obstet Gynecol Reprod Biol 2012;165(2):342–346. DOI: 10.1016/j.ejogrb.2012.08.016.
Beyer DA, Rody A, Schmidt N, et al. Excisions of severe cervical dysplasia: Are there mandatory diameters of the cone that need to be considered? J Turk Ger Gynecol Assoc 2017;18(4):185–189. DOI: 10.4274/jtgga.2017.0036.