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Abstract
Introduction/Background National Health Service Cervical Screening Programme(NHSCSP) aims to reduce the incidence of, and mortality from, cervical cancer. Women with high-grade CIN are offered treatment, usually excisional. Depth of excision(DoE) standards for these women have been defined by NHSCSP according to their Transformation Zone Types(TZT)1. In women of reproductive age, excisions of >10 mm are not associated with improved recurrence rates, however are associated with an increased risk of preterm delivery2. Patients receive Test of Cure(ToC) smears at 6 months to determine if they are free of disease.Our aim is to determine success rates of ToC, in regards to DoE standards.
Methodology A continuous cohort of patients treated with loop excision for high-grade CIN were extracted retrospectively from MASEY Database, dated 01/01/2020–30/04/2020. Data was collected using OpenExeter/Telepath databases and analysed on Microsoft Office, Excel.
Results A total of 123 women received loop excision for high-grade CIN. We met DoE standards for 38%(n=47), did not meet standards for 50%(n=61) and TZT was not recorded for 12%(n=15). Of patients with TZT1, we met standards for 61%(n=39), for TZT2 this was 32%(n=7) and 5%(n=1) for TZT3. Overall success rate of ToC was 65%(n=80), failed ToC was 19%(n=23) and ToC was not recorded for 16%(n=20). For TZT1, when standards were not met, 80%(n=20) had successful ToC, compared to 70%(n=27) when standards were met. For TZT2, when standards were not met, 67%(n=10) had successful ToC, compared to 86%(n=6) when standards were met. For TZT3, when standards were not met, 48%(n=7) had successful ToC, compared to 0%(n=1). For patients of reproductive age (n=32), 75%(n=24) had excision depth <10 mm and 25%(n=8) had ≥10 mm excision.
TZTs and Depth of Excision Standards
Conclusion Our unit is taking shallower loops than recommended. This only appears to adversely affect the success of ToC for TZT2&3. Different modalities of excisional treatment can be introduced to increase compliance.