Introduction/Background Loop electrosurgical excision procedure (LEEP) is the most frequently used therapeutic approach in pre-invasive cervical diseases. Surgical margin positivity is a big debate among gynecologists and there are several reports showing the importance of HPV 16–18, pap-smear results, age of the patient, or size of the lesion. This study evaluates the risk factors for surgical margin positivity among patients who were subjected to LEEP for pre-invasive cervical lesions in a tertiary colposcopy center.
Methodology Patients with pre-invasive cervical lesions who underwent LEEP were retrospectively evaluated. Patients who were not tested for high-risk HPV were excluded. Patients were evaluated for margin positivity with respect to pap-smear result (normal vs. ≥ASC-US), age (≤40 vs. >40 years), lesion size (≤2 cm vs. >2 cm) and HPV type (16–18 vs. other high-risk HPV). Student-t test and chi-square test were used for comparison.
Results A total of 321 patients constituted the study group. Among the study group, 79 (24.6%) patients had margin positivity. Comparison of this group with 242 (75.4%) margin negative patients revealed that abnormal pap-smear and HPV 16 and/or 18 positivity were significantly associated with margin positivity (table 1). Pap-smear abnormality (≥ASC-US) was seen in 58 (73.4%) of margine positive cases whereas only 118 (49.0%) with margin negativity had abnormal smear (p<0.001, OR: 3.1; 95% CI: 1,7–5,6). This risk association did not differ for different Pap-smear abnormality thresholds (LSIL, HSIL etc). Being positive for HPV 16–18 was also a risk factor for margin positivity (75.9% vs. 43.4%, p<0.001, OR: 4.4; 95%CI: 2.45–7.96). However, neither age (p=0.5) nor the lesion size (p=0.8) was a significant factor for margin positivity. Among 79 margin positive cases, 33 (41.7%) had re-LEEP, 13 (16.5%) had cold-knife conization, 13 (16.5%) had hysterectomy, and 12 (15.1%) were just followed-up while 8 (10.2%) were lost to follow up after the LEEP procedure. Among patients who had re-LEEP or conization (n=46), 7 patients (15,2%) had still positive surgical margine after the second procedure (5 in re-LEEP (15,1%), 2 in cold knife conization (15,4%)).
Conclusion Patients with HPV 16–18 and/or Pap-smear abnormality (≥ASC-US) should be carefully evaluated before LEEP procedure for a possible margin positivity. In such cases, larger excisions may be considered to decrease the risk of margin positivity especially if the patient has no future fertility desire.
Disclosures No conflict of interest to declare.
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