World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 12, Number 4, August 2021, pages 111-118

Treatment Outcomes of Patients With Cervical Intraepithelial Neoplasia or Invasive Carcinoma Who Underwent Loop Electrosurgical Excision Procedure

Figure 1. Progression-free survival (persistent or recurrent diseases) and clinical-pathological features. (a) Age group. (b) HIV infection status. (c) Final diagnosis of preinvasive or invasive cervical cancer. (d) Margin status after first LEEP. HIV: human immunodeficiency virus; LEEP: loop electrosurgical excision procedure.

**Table 1.** General Characteristics of Patients Underwent LEEP (N = 385)
Characteristic	n (%)
HIV: human immunodeficiency virus; ASC-US: atypical squamous cells of undetermined significance; ASC-H: atypical squamous cells cannot exclude HSIL; LSIL: low-grade squamous cell intraepithelial lesion; HSIL: high-grade squamous cell intraepithelial lesion; CIS: carcinoma in situ; SCC: squamous cell carcinoma; AGC: atypical glandular cells; AIS: adenocarcinoma in situ; NILM: negative for intraepithelial lesion or malignancy; CIN: cervical intraepithelial neoplasia.
Age (mean), years	41.9 ± 10.8
Parity
Null	71 (18.4)
1	114 (29.6)
2 - 3	179 (46.5)
≥ 4	21 (5.5)
Pre-menopause	301 (78.2)
Smoking	6 (1.6)
HIV infection	59 (15.3)
Initial cervical cytology
ASC-US	81 (21.0)
ASC-H	26 (6.8)
LSIL	72 (18.7)
HSIL	170 (44.1)
CIS	3 (0.8)
SCC	15 (3.9)
AGC	13 (3.4)
AIS	1 (0.3)
NILM	4 (1.0)
Cervical biopsy results
Not done	7 (1.8)
Negative for CIN or inflammation	17 (4.5)
CIN 1	36 (9.4)
CIN 2/3	296 (76.9)
CIS	21 (5.5)
SCC	7 (1.8)
AIS	1 (0.3)

Table 1. General Characteristics of Patients Underwent LEEP (N = 385)

Characteristic

n (%)

HIV: human immunodeficiency virus; ASC-US: atypical squamous cells of undetermined significance; ASC-H: atypical squamous cells cannot exclude HSIL; LSIL: low-grade squamous cell intraepithelial lesion; HSIL: high-grade squamous cell intraepithelial lesion; CIS: carcinoma in situ; SCC: squamous cell carcinoma; AGC: atypical glandular cells; AIS: adenocarcinoma in situ; NILM: negative for intraepithelial lesion or malignancy; CIN: cervical intraepithelial neoplasia.

Age (mean), years

41.9 ± 10.8

Parity

Null

71 (18.4)

114 (29.6)

2 - 3

179 (46.5)

≥ 4

21 (5.5)

Pre-menopause

301 (78.2)

Smoking

6 (1.6)

HIV infection

59 (15.3)

Initial cervical cytology

ASC-US

81 (21.0)

ASC-H

26 (6.8)

LSIL

72 (18.7)

HSIL

170 (44.1)

CIS

3 (0.8)

SCC

15 (3.9)

AGC

13 (3.4)

AIS

1 (0.3)

NILM

4 (1.0)

Cervical biopsy results

Not done

7 (1.8)

Negative for CIN or inflammation

17 (4.5)

CIN 1

36 (9.4)

CIN 2/3

296 (76.9)

CIS

21 (5.5)

SCC

7 (1.8)

AIS

1 (0.3)

**Table 2.** Histologic Outcome After First LEEP (N = 385)
Results	n (%)
CIN: cervical intraepithelial neoplasia; CIS: carcinoma in situ; AIS: adenocarcinoma in situ; LEEP: loop electrosurgical excision procedure.
Complications
Bleeding	16 (4.2)
Infection	12 (3.1)
Final diagnosis
CIN 1	16 (4.2)
CIN 2/3	321 (83.4)
CIS	24 (6.2)
Squamous cell carcinoma stage IA1	14 (3.6)
Squamous cell carcinoma stage IA2	1 (0.2)
Squamous cell carcinoma stage IB1	3 (0.8)
AIS	3 (0.8)
Adenocarcinoma stage IB1	3 (0.8)
Margin status after first LEEP
Negative margin	232 (60.3)
Positive ectomargin	40 (10.4)
Positive endomargin	79 (20.5)
Positive both margins	34 (8.8)

Table 2. Histologic Outcome After First LEEP (N = 385)

Results

n (%)

CIN: cervical intraepithelial neoplasia; CIS: carcinoma in situ; AIS: adenocarcinoma in situ; LEEP: loop electrosurgical excision procedure.

Complications

Bleeding

16 (4.2)

Infection

12 (3.1)

Final diagnosis

CIN 1

16 (4.2)

CIN 2/3

321 (83.4)

CIS

24 (6.2)

Squamous cell carcinoma stage IA1

14 (3.6)

Squamous cell carcinoma stage IA2

1 (0.2)

Squamous cell carcinoma stage IB1

3 (0.8)

AIS

3 (0.8)

Adenocarcinoma stage IB1

3 (0.8)

Margin status after first LEEP

Negative margin

232 (60.3)

Positive ectomargin

40 (10.4)

Positive endomargin

79 (20.5)

Positive both margins

34 (8.8)

**Table 3.** Outcome of Subsequent LEEP or Hysterectomy
Results	n (%)
*Some hysterectomy specimens had more than one pathology. LEEP: loop electrosurgical excision procedure; CIN: cervical intraepithelial neoplasia; SCC: squamous cell carcinoma; MIC: microinvasive carcinoma.
Indications of subsequent LEEP (n = 43)
Positive margins(s)	38 (88.4)
Recurrent CIN	5 (11.6)
Margin status after subsequent LEEP (n = 43)
Negative margin	39 (90.7)
Positive margin	4 (9.3)
Pathology of subsequent LEEP specimens (n = 43)
Negative or cervicitis	14 (32.6)
CIN 1	11 (25.6)
CIN 2/3	16 (37.2)
SCC	2 (4.6)
Indications of hysterectomy (n = 76)
Persistent or recurrent CIN	37 (48.7)
Microinvasive or invasive carcinoma	19 (25.0)
Other gynecologic conditions	20 (26.3)
Pathology of hysterectomy* (n = 76)
Negative finding	20 (26.3)
Residual CIN	26 (34.2)
MIC	3 (3.9)
Invasive SCC or adenocarcinoma	2 (2.6)
Myoma or adenomyosis	35 (46.1)
Benign ovarian tumor	7 (9.2)
Epithelial ovarian cancer	1 (1.3)

Table 3. Outcome of Subsequent LEEP or Hysterectomy

Results

n (%)

*Some hysterectomy specimens had more than one pathology. LEEP: loop electrosurgical excision procedure; CIN: cervical intraepithelial neoplasia; SCC: squamous cell carcinoma; MIC: microinvasive carcinoma.

Indications of subsequent LEEP (n = 43)

Positive margins(s)

38 (88.4)

Recurrent CIN

5 (11.6)

Margin status after subsequent LEEP (n = 43)

Negative margin

39 (90.7)

Positive margin

4 (9.3)

Pathology of subsequent LEEP specimens (n = 43)

Negative or cervicitis

14 (32.6)

CIN 1

11 (25.6)

CIN 2/3

16 (37.2)

SCC

2 (4.6)

Indications of hysterectomy (n = 76)

Persistent or recurrent CIN

37 (48.7)

Microinvasive or invasive carcinoma

19 (25.0)

Other gynecologic conditions

20 (26.3)

Pathology of hysterectomy* (n = 76)

Negative finding

20 (26.3)

Residual CIN

26 (34.2)

MIC

3 (3.9)

Invasive SCC or adenocarcinoma

2 (2.6)

Myoma or adenomyosis

35 (46.1)

Benign ovarian tumor

7 (9.2)

Epithelial ovarian cancer

1 (1.3)

**Table 4.** Risk of Persistent/Recurrent CIN According to Clinical and/or Histopathologic Features (N = 385)
Characteristic/histopathology	n	Persistence/recurrence, n (%)	Univariate	Multivariate
CIN: cervical intraepithelial neoplasia; HIV: human immunodeficiency virus; ASC-H: atypical squamous cells cannot exclude HSIL; HSIL: high-grade squamous cell intraepithelial lesion; CIS: carcinoma in situ; MIC: microinvasive carcinoma; CI: confidence interval.
Age ≥ 55 years	45	13 (28.9)	3.5 (1.7 - 7.6)	< 0.001*	4.8 (1.5 - 15.0)	0.008*
Parity ≥ 4	21	5 (23.8)	2.4 (0.8 - 6.9)	0.09	-	-
Menopause	84	16 (19.0)	2.0 (1.1 - 4.0)	0.03*	1.0 (0.4 - 2.6)	0.94
Smoking	6	1 (16.7)	1.4 (0.2 - 12.7)	0.74	-	-
HIV infection	59	13 (22.0)	2.4 (1.2 - 4.9)	0.01*	3.1 (1.3 - 7.1)	0.009*
Cytology of ASC-H, ≥ HSIL	215	36 (16.7)	2.9 (1.4 - 5.9)	0.002*	1.9 (0.9 - 4.2)	0.12
Final diagnosis cancer	21	10 (47.6)	8.0 (3.2 - 21.2)	< 0.001*	6.0 (1.9 - 18.7)	0.02*
Positive margin
Ectomargin	40	4 (10.0)	2.0 (0.6 - 6.7)	0.23	-	-
Endomargin	79	14 (17.7)	3.9 (1.7 - 9.0)	0.001*	1.7 (1.2 - 2.7)	0.02*
Both margins	34	17 (50.0)	10.7 (5.0 - 23.1)	< 0.001*	10.1 (4.2 - 24.2)	< 0.001*

Table 4. Risk of Persistent/Recurrent CIN According to Clinical and/or Histopathologic Features (N = 385)

Characteristic/histopathology

Persistence/recurrence, n (%)

Univariate

Multivariate

Hazard ratio (95% CI)

CIN: cervical intraepithelial neoplasia; HIV: human immunodeficiency virus; ASC-H: atypical squamous cells cannot exclude HSIL; HSIL: high-grade squamous cell intraepithelial lesion; CIS: carcinoma in situ; MIC: microinvasive carcinoma; CI: confidence interval.

Age ≥ 55 years

13 (28.9)

3.5 (1.7 - 7.6)

< 0.001*

4.8 (1.5 - 15.0)

0.008*

Parity ≥ 4

5 (23.8)

2.4 (0.8 - 6.9)

0.09

Menopause

16 (19.0)

2.0 (1.1 - 4.0)

0.03*

1.0 (0.4 - 2.6)

0.94

Smoking

1 (16.7)

1.4 (0.2 - 12.7)

0.74

HIV infection

13 (22.0)

2.4 (1.2 - 4.9)

0.01*

3.1 (1.3 - 7.1)

0.009*

Cytology of ASC-H, ≥ HSIL

215

36 (16.7)

2.9 (1.4 - 5.9)

0.002*

1.9 (0.9 - 4.2)

0.12

Final diagnosis cancer

10 (47.6)

8.0 (3.2 - 21.2)

< 0.001*

6.0 (1.9 - 18.7)

0.02*

Positive margin

Ectomargin

4 (10.0)

2.0 (0.6 - 6.7)

0.23

Endomargin

14 (17.7)

3.9 (1.7 - 9.0)

0.001*

1.7 (1.2 - 2.7)

0.02*

Both margins

17 (50.0)

10.7 (5.0 - 23.1)

< 0.001*

10.1 (4.2 - 24.2)

< 0.001*