Recurrence after Treatment by Loop Electrosurgical Excision Procedure (LEEP) of High-Grade Cervical Intraepithelial Neoplasia

Abstract

Purpose

To evaluate the recurrence rate of high-grade CIN treated by loop electrosurgical excision procedure (LEEP) and the optimal follow-up schedule.

Method

622 cases of CIN2/3 consecutively treated by LEEP in the Florence screening program, with 66.5 months average follow-up (range, 6–195 months), were evaluated. Recurrence was defined as histological evidence of high-grade CIN.

Results

The average recurrence rate was 9.1% (52 cases). Recurrence was significantly associated to increasing age (χ² = 12.73, df = 3, P < 001), CIN grade (10.5 vs 6.1%, χ² = 3.37, df = 1, P = 0.067), and time interval, with the risk of developing a recurrence highest in the first year (7.4%, 95% confidence interval, 5.3–9.5%.), and rare beyond the third year. Multivariate analysis confirmed a significant independent association of age (particularly over age 40) and CIN grade to the risk of recurrence.

Conclusions

LEEP is an effective procedure for the treatment of high-grade CIN. Most recurrences after LEEP occur in the first 3 years, and non-recurrent cases at that date may stop intensive follow-up and return to current cytological screening every 3 years.