Recurrent Rates with Cervical Intraepithelial Neoplasia having a Negative Surgical Margin after the Loop Electrosurgical Excision Procedure in Thailand

LEEP conization has become the treatment of choice in patients presenting with high grade intraepithelial lesions (HSILs) especially in cases with negative surgical margins. However, surveillance after such treatment is necessary due to the potential for recurrence. To evaluate the recurrent rate in patients with negative surgical margins after HSIL treatment with LEEP, the medical records of such patients treated between January 2000 and June 2007 were reviewed. All of them subsequently underwent Pap smears every 4-6 months to detect the recurrence of cervical intraepithelial neoplasia. There were 272 patients in the study period. Of these, 9 (3.3%) developed abnormal Pap smears with a median follow up of 12 months. The abnormal smears featured: atypical squamous cells of undetermined significance in 5 cases; atypical squamous cells where high grade squamous cell intraepithelial lesion cannot be excluded in 2 cases; and low grade squamous intraepithelial lesions in the 2 remaining cases. Further investigation with colposcopic directed biopsies were conducted in all who exhibited an abnormal Pap smear and only 3 of them (1.1%) showed cervical dysplasia at biopsy. In conclusion, the patients with HSIL who were treated with LEEP and have negative surgical margins have a very low recurrence rate.