Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years.

OBJECTIVE

To establish the effect of margin status on recurrence following large loop excision of the transformation zone (LLETZ) in women over 50 years.

STUDY

DESIGN

Prospectively collected data of women over 50 years, who underwent LLETZ for suspected cervical intraepithelial neoplasia between 1998 and 2003, were analysed. Women were followed up for up to over 6 years.

SETTING

District colposcopy service based at a gynae-oncology cancer centre.

MAIN OUTCOME MEASURES: The main outcome measure included histologically detected recurrence. Any abnormal cytology on follow up was also documented.

METHODS

Prospectively collected data were analysed from the colposcopy database. Recurrence was analysed using Kaplan-Meir plots and Cox regression. Fisher's exact test was used to determine the association between margins and grade. The Kruskal-Wallis and Mann-Whitney U tests were used to compare age and duration of follow up between groups.

RESULTS

A total of 118 women underwent LLETZ and 92 were included in the final analysis. Margins were designated as clear (n = 62), involved (n = 22) or uncertain (n = 8). Histological recurrence occurred in 12 while abnormal cytology was demonstrated in 17 women. One woman with involved margins developed cervical cancer. Individuals with clear margins were less likely to have recurrence than those with involved margins (Hazard Ratio (HR) 0.18, 95% CI: 0.06-0.59). Involved margins were more common with high-grade than low-grade lesions (P = 0.002).

CONCLUSION

The data show an association between disease recurrence and the finding of involved margins in this cohort.