Predictors of residual disease after loop electrosurgical excision procedure

The study aims to evaluate the importance of resection margins in the risk of residual disease (RD) and to investigate other factors that could potentially predict RD before patients engage in follow-up. Eighty-six women with a histologically confirmed diagnosis of cervical intraepithelial neoplasms (CIN) treated by loop electrosurgical excision procedure (LEEP), were included in this retrospective study, between January 2015 and May 2016. Age, smoking habit, menopause status, and LEEP margins were evaluated as possible predictors of RD. The mean age at diagnosis was 35.8 years (range 18-61). The mean follow-up period was 12 months. 11.6% of patients (09/86) were lost in follow-up. 64% of patients (55/86) had clear margins in the specimen and 34.8% of patients had positive surgical margins (30/86). In 1.2% of patients (01/86) the resection margins were uncertain. RD was demonstrated by positive Pap Smear and by colposcopy-guided biopsy in 26.7% of patients (23/86). We found significant differences in the frequency of RD depending on the status of margins: 65.2% of cases with positive margins vs. 24.5% of cases with negative margins (p<0.0001). Multivariate analysis showed that only high-grade squamous intraepithelial lesion (H-SIL) detection in cervical biopsy and status of the LEEP margins were significantly predictive of RD (OR 5.4, 95%CI 1.08-27.7, p<0.05 and OR 7.05, 95%CI 2.1-23.1, p=0.001; respectively). The combination of histological examination of resection margins plus H-SIL detection in cervical biopsy would help to classify LEEP-treated patients into categories of different risk levels of residual disease.