Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Snijvlakken van lisexcisie niet van invloed op persisterende cervixafwijkingen

(2019) Eising, M. (Manon)

Introduction In January 2017 a new guideline on cervical cytology has been introduced. Which advises that high-risk human papillomavirus (hrHPV) should be screened before cervix cytology is determined. When a patient is hrHPV positive and has a ≥ pap 2, referral to a gynecologist to perform a colposcopy is indicated. The number of referrals because of the new guideline has increased and more colposcopies are performed. Subsequently, more women are subjected to a large loop excision of the transformation zone (LLETZ). To date, little is known about the clinical relevance of positive margins after LLETZ. Hence, this study will assess the statistical relevance of margins after LLETZ on the presence of cervical intra-epithelial neoplasia (CIN). Methods In this study, 233 women were included who had undergone a LLETZ between January 2017 and July 2018. Data on HPV status, cervical cytology (pap stage) before LLETZ, complications of LLETZ procedure, and cervical cytology was collected during a follow-up of ± one year. Chi-square tests were utilized to assess potential difference between groups. Results Women with positive margins after LLETZ did not have more persistent CIN lesions compared to women with negative margins in this study (p=0,19). Women with positive margins did not experience more complications than women with negative margins (p=0,19). Women with negative margins cleared HPV more often than women with positive margins (p=0,01). Also women under age 50 cleared HPV more often than women over the age of 50 (p=0,01). Conclusion This study shows that positive margins after LLETZ are not associated with a higher number of cervical abnormalities (≥ pap 2). HPV is an important predictor of recurrence of CIN. The result of this study demonstrate, that a more conservative treatment plan/follow-up could be considered for patients after LLETZ procedure.

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