Multivariate analysis of risk factors for the persistence of high-grade squamous intraepithelial lesions following loop electrosurgical excision procedure

Objective: To evaluate risk factors related to the persistence of high-grade squamous intraepithelial lesions (HSILs) following loop electrosurgical excision procedure (LEEP). Methods: The present prospective, observational study evaluated a convenience sample of participants with HSILs who were treated using LEEP between January 7,2003 and December 30, 2011. Participants were evaluated 6 months and 1 year after treatment. Potential risk factors included in multivariate analyses were HIV co-infection, involved margins, multicentric lesions, smoking, and use of hormonal contraception. Results: The present study enrolled 307 participants. At 1 year, 250 (81.4%) participants were free from lesions, 30 (9.8%) had low-grade squamous intraepithelial lesions, 26 (8.5%) had persistent HSILs, and 1 (0.3%) had developed invasive carcinoma. The risk of lesions persisting at 1 year after LEEP was increased by HIV infection (P = 0.003), involved margins (P = 0.05), and smoking (P = 0.02). The presence of multicentric lesions (P = 0.73) and the use of hormonal contraception (P = 0.99) did not increase the risk of lesion persistence. The risk of HSIL persistence was increased by the presence of involved margins (relative risk 3.25; 95% confidence interval 1.55-6.80; P = 0.001). Conclusions: The presence of involved margins was the only variable that increased the risk of HSIL persistence after LEEP, increasing the risk of patients requiring further treatment. (C) 2016 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.