Value of Second Pass in Loop Electrosurgical Excisional Procedure

The aim of this study was to compare the rate of incomplete resection and treatment outcome of the second-pass technique with those of single-pass technique in loop electrosurgical excisional procedure (LEEP). From 1997 to 2002, 683 women were diagnosed as squamous dysplasia via LEEP in our institution. Age, parity, LEEP technique, grade of lesion, glandular extension, margin status, residual tumor and recurrence were obtained by reviewing medical records. Positive margin was defined as mild dysplasia or higher grade lesions at resection margin of the LEEP specimen. In women who underwent hysterectomy, residual tumor was defined as mild dysplasia or higher grade lesions in hysterectomy specimen. In women who did not underwent hysterectomy, Pap smear more than atypical squamous cells of undetermined significance or biopsy result more than mild dysplasia within two years after LEEP were regarded as cytologic or histologic recurrences, respectively. Treatment failure of LEEP was defined as residual tumor or histologic recurrence. The second-pass technique significantly reduced the endocervical margin positivity (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63). However, the second-pass technique did not reduce the treatment failure (OR, 0.62; 95% CI, 0.29-1.32). In conclusion, the second-pass technique markedly reduced the endocervical margin positivity, but did not reduce the treatment failure rate of LEEP.

Management of Patients with CIN III and Positive Margins After Cervical Conization / 대한산부인과학회잡지

OBJECTIVE: To evaluate conservative management of patients with cervical intraepithelial lesion, grade III (CIN III) and positive resection margins after cervical conization. METHODS: We reviewed records of 64 patients undergoing cervical conization revealing CIN III with positive resection margins between January 1997 and December 1999. Thirty-three (51.5%) patients underwent conization only and thirty-one (48.5%) underwent conization and subsequent hysterectomy. These patients were followed up with a Pap smear every 3-6 months and then persistence and recurrence were determined in each group. The sites of incomplete excision and HPV infection at cone and residual lesion at hysterectomy specimen were evaluated. RESULTS: Thirty-one of 33 patients receiving conservative management and all 31 patients receiving subsequent hysterectomy had negative Pap smear (P=0.262). In the group of the conservative management, one case of 11 patients with extension to the endocervical margin had positive Pap smear (P=0.577). One of 17 cases with HPV infection and one of 10 cases with negative HPV testing had positive cytology (P=0.630). In the group of subsequent hysterectomy, nine cases (42.86%) of 21 patients with extension to endocervical margin and two (22.22%) of 9 patients with extension to exocervical margin had residual lesion in hysterectomy specimen (P=0.258). Only one (8.33%) of 12 cases with positive HPV and five (50%) of 10 patients with negative HPV had residual lesion (P=0.043). CONCLUSION: Patients with CIN III and positive resection margins after cervical conization can be followed appropriately with serial cytology. Endocervical margin involvement and HPV infection were not statistically significant predictors of residual lesion, persistence and recurrence in our patients.