Predictive factors for residual disease in the uterine cervix after large loop excision of the transformation zone in patients with cervical intraepithelial neoplasia III.

OBJECTIVE: To determine predictive factors for residual disease in uterine cervix after large loop excision of the transformation zone (LLETZ) in patients with cervical intraepithelial neoplasia III (CIN III). MATERIAL AND METHOD: Medical records of patients who underwent LLETZ with CIN III between September 1, 1992 and December 31, 2001 in Ramathibodi Hospital were reviewed. Demographic data, colposcopic findings, and pathologic parameters were analyzed to identify the predictive factors for residual disease in uterine cervix. RESULTS: The total of 541 cases were enrolled in this study. Managements after LLETZ are 1) repeated LLETZ, 2) hysterectomy, and 3) Papanicolaou smear. Residual disease was detected in a total of 156 patients (28.84%), there were 21 cases of CIN I (13.46%), 22 cases of CIN II (14.10%), 107 cases of CIN III (68.59%), and 6 (3.85%) cases of microinvasive squamous cell carcinoma of cervix. 1) Age > or = 50 years old was significant factor associated with residual disease. The incidence of residual disease was 50.00%. 2) Unsatisfactory colposcopy was significant factor associated with residual disease with 38.44% incidence of residual disease. 3) Margins involvement of LLETZ specimen was the only pathological predictive factor identified. The incidence of residual disease with clear margin, endocervical margin, ectocervical margin, and both margins involvement were 14.74, 52.63, 57.14, and 74.19% respectively. Other parameters, including gravidity, parity, menopausal status, cervical gland involvement, and number of quadrants involvement were not predictive of residual disease. CONCLUSION: 1) Age > or = 50 years old, 2) unsatisfactory colposcopy, and 3) margins involvement of LLETZ specimens were the predictive factors for residual disease in uterine cervix.

Detection of residual disease by cytology in patients with cervical intraepithelial neoplasia III post-large loop excision of the transformation zone.

OBJECTIVE: To evaluate the diagnostic accuracy of cytology in detecting residual disease in patients with cervical intraepithelial neoplasia (CIN) III post-large loop excision of the transformation zone (LLETZ). METHODS: This prospective study was performed between February 1994 and August 1999 at the Department of Obstetrics and Gynecology, Ramathibodi Hospital, and involved 90 patients who underwent LLETZ and had histologic confirmation of CIN III. Simple hysterectomy was performed in all patients 2-3 months after LLETZ. Two Papanicolaou smears were taken using Ayre spatula on each patient 6 weeks after LLETZ and 1 day before hysterectomy. Histologic findings of hysterectomy specimens were used as the 'gold standard'. RESULTS: Forty-six cases (51.1%) were found to have residual diseases: seven cases with CIN I, 11 cases with CIN II, 27 cases with CIN III and one case with invasive squamous cell carcinoma. Using the most severe diagnosis of two Papanicolaou smears performed on each patient as the cytologic diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value were 28.3, 93.2, 81.3 and 55.4%, respectively. The accuracy rate was 60.0%. Residual diseases were found in 62.5 and 39.0% of cases with the presence and absence of CIN at the margin of the LLETZ specimen, respectively. CONCLUSION: Cytology using the Ayre spatula has low accuracy in detecting residual disease in the cervix post-LLETZ.