The predictive value of LEEP specimen margin status for residual/recurrent cervical intraepithelial neoplasia

The objective of this study was to determine the impact of margin status of LEEP specimens on the rate of recurrent/residual cervical intraepithelial neoplasia (CIN). Also, we determined the effect of other clinical or pathologic factors on recurrent/residual disease. In this prospective cohort study, 227 women underwent LEEP excision of the cervix using standard techniques. Data concerning clinical factors and pathologic and cytologic results were collected. Patients had follow-up at three month intervals with Pap smears and indicated colposcopy/biopsy. 145/227 were confirmed as having CIN in the LEEP specimen. 66/145 (45%) had involved (positive) margins, and 79/145 (55%) had noninvolved (negative) margins. 27/57 (47%) with positive margins had recurrent disease compared with 22/65 (34%) with negative margins. (P = 0.18) HIV infection was found in 8/227 (3.6%). 8/8 HIV-infected patients had involved margins and recurrent/residual disease. Endocervical curettage (ECC) was positive in 39 cases and negative in 106. 13/34 (38%) cases with a positive ECC had recurrent disease vs. 32/88 (36%) with a negative ECC. (P = 0.85) Also, 8/58 (14%) patients whose specimens did not show CIN were found to have CIN at follow-up. In conclusion, the risk of residual/recurrent CIN at follow-up after undergoing LEEP is not statistically different in margin positive vs. margin negative patients (47% vs. 34%) (P = 0.18) or ECC positive vs. ECC negative patients. (38% vs. 36%) (P = 0.85) If HIV infected patients are excluded, the rate of recurrent disease in the two groups is very similar. (39% vs. 34%) (P = 0.73) Follow-up is important for patients with negative LEEP specimens as 14% were later diagnosed with GIN.