OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for hi...OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for high-grade squamous intraepithelial lesions by loop excision between January 1990 and December 1999 were identified. Demographic information, pathologic diagnosis, and follow-up visits were extracted from medical records. Follow-up data included all Papanicolaou (Pap) tests and/or cervical biopsies performed in our clinic after the initial procedure. RESULTS: Women (n = 705) were treated for biopsy-proven high-grade dysplasia. Of those treated, 526 (74%) had at least 1 follow-up Pap test performed in our clinics within 2 years of their original procedure. During the 2 years of posttreatment surveillance, 70 (13.3%) women demonstrated recurrent cervical intraepithelial neoplasia 2 or 3. Recurrence was highest during the first 6 months and between months 22 and 24 of surveillance. This rate was noted to be dramatically lower during months 7 to 21 of surveillance (P < .001). Increasing age was independently associated with a 1.6-fold per decade (95%confidence interval 1.29, 1.9) increase in risk of recurrence. A negative margin status was independently associated with a 0.29-fold (95%confidence interval 0.17, 0.5) decrease in risk of recurrence. Race was not shown to have an influence on risk of recurrence. CONCLUSION: A clinically and financially optimal surveillance schedule for women treated for high-grade dysplasia with loop excision would be to obtain Pap tests every 6 months for 1 year and then return to annual screening. Lengthening the surveillance intervals could be beneficial to patients, while decreasing healthcare costs, without compromising the ability to detect and treat recurrent disease.展开更多
OBJECTIVE: We sought to estimate the incidence and clinical significance of a negative therapeutic loop electrosurgical excision procedure (LEEP) and to evalu ate patient specimens for limiting histologic features ass...OBJECTIVE: We sought to estimate the incidence and clinical significance of a negative therapeutic loop electrosurgical excision procedure (LEEP) and to evalu ate patient specimens for limiting histologic features associated with a negativ e LEEP. METHODS: We identified 674 patients with biopsy-confirmed high-grade c ervical dysplasia who were treated with LEEP from 1991 through 2001. The results of these LEEP procedures were reviewed for the absence of dysplasia or the pres ence of cervical intraepithelial neoplasia stages 1-3. Computerized pathology f iles of patients were then reviewed through July 2002 to determine whether dyspl asia recurred. Slides of negative LEEP specimens were reviewed to confirm the ab sence of dysplasia and to search for histologic features that may have limited o ur interpretation of the specimen. RESULTS: Ninety-three (14%)of LEEP specimen s reviewed were completely negative for dysplasia. Clinical follow-up was avail able on 75 of the 93 patients, with a median follow-up time of 2 years. Eightee n (24%) patients had subsequent positive follow-up, including carcinoma (n = 2 ), high-grade squamous intraepithelial lesions (n = 8), low-grade squamous int raepithelial lesion (n = 6), and atypical squamous cells of undetermined signifi cance (n = 2). Patients with negative LEEPs had a recurrence rate similar to pat ients with positive LEEPs (24%versus 27%). Limiting histologic features were m ore commonly identified in negative LEEPs as compared with LEEPs containing dysplasia (16% versus 5%, P < .001). CONCLUSION: A negative LEEP is not an uncommon finding, o ccurring in 14%(95%confidence interval 11-17%) of specimens at our instituti on. Negative LEEPs are more likely to contain histologic features that limit pat hology interpretation. A negative LEEP is not a reassuring finding and was assoc iated with a recurrence rate similar to those of a positive LEEP. Both negative and positive populations should be carefully followed.展开更多
文摘OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for high-grade squamous intraepithelial lesions by loop excision between January 1990 and December 1999 were identified. Demographic information, pathologic diagnosis, and follow-up visits were extracted from medical records. Follow-up data included all Papanicolaou (Pap) tests and/or cervical biopsies performed in our clinic after the initial procedure. RESULTS: Women (n = 705) were treated for biopsy-proven high-grade dysplasia. Of those treated, 526 (74%) had at least 1 follow-up Pap test performed in our clinics within 2 years of their original procedure. During the 2 years of posttreatment surveillance, 70 (13.3%) women demonstrated recurrent cervical intraepithelial neoplasia 2 or 3. Recurrence was highest during the first 6 months and between months 22 and 24 of surveillance. This rate was noted to be dramatically lower during months 7 to 21 of surveillance (P < .001). Increasing age was independently associated with a 1.6-fold per decade (95%confidence interval 1.29, 1.9) increase in risk of recurrence. A negative margin status was independently associated with a 0.29-fold (95%confidence interval 0.17, 0.5) decrease in risk of recurrence. Race was not shown to have an influence on risk of recurrence. CONCLUSION: A clinically and financially optimal surveillance schedule for women treated for high-grade dysplasia with loop excision would be to obtain Pap tests every 6 months for 1 year and then return to annual screening. Lengthening the surveillance intervals could be beneficial to patients, while decreasing healthcare costs, without compromising the ability to detect and treat recurrent disease.
文摘OBJECTIVE: We sought to estimate the incidence and clinical significance of a negative therapeutic loop electrosurgical excision procedure (LEEP) and to evalu ate patient specimens for limiting histologic features associated with a negativ e LEEP. METHODS: We identified 674 patients with biopsy-confirmed high-grade c ervical dysplasia who were treated with LEEP from 1991 through 2001. The results of these LEEP procedures were reviewed for the absence of dysplasia or the pres ence of cervical intraepithelial neoplasia stages 1-3. Computerized pathology f iles of patients were then reviewed through July 2002 to determine whether dyspl asia recurred. Slides of negative LEEP specimens were reviewed to confirm the ab sence of dysplasia and to search for histologic features that may have limited o ur interpretation of the specimen. RESULTS: Ninety-three (14%)of LEEP specimen s reviewed were completely negative for dysplasia. Clinical follow-up was avail able on 75 of the 93 patients, with a median follow-up time of 2 years. Eightee n (24%) patients had subsequent positive follow-up, including carcinoma (n = 2 ), high-grade squamous intraepithelial lesions (n = 8), low-grade squamous int raepithelial lesion (n = 6), and atypical squamous cells of undetermined signifi cance (n = 2). Patients with negative LEEPs had a recurrence rate similar to pat ients with positive LEEPs (24%versus 27%). Limiting histologic features were m ore commonly identified in negative LEEPs as compared with LEEPs containing dysplasia (16% versus 5%, P < .001). CONCLUSION: A negative LEEP is not an uncommon finding, o ccurring in 14%(95%confidence interval 11-17%) of specimens at our instituti on. Negative LEEPs are more likely to contain histologic features that limit pat hology interpretation. A negative LEEP is not a reassuring finding and was assoc iated with a recurrence rate similar to those of a positive LEEP. Both negative and positive populations should be carefully followed.
