Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment

Abstract

Objective To quantify and analyse the influence of a histological report of incomplete excision of CIN after LLETZ on frequency of detection of residual CIN. Design Review of a computerised database of sequential women treated by LLETZ. Initial follow-up was three months post-treatment. Setting The Colposcopy Clinic, Regional Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK. Subjects 721 women with CIN diagnosed histologically on LLETZ specimens. Results In spite of a first time treatment success rate of 95% at 3 months, only 56% of the women were reported to have complete histological excision of CIN. A report suggesting incomplete excision was more likely with more severe CIN, extensive lesions and involvement of the endocervical canal. Furthermore, 21 % with residual CIN had apparent complete excision of CIN at LLETZ. Conclusions A histological report of incomplete excision of CIN at LLETZ does not equate with residual disease. The high treatment success rate of LLETZ means that a report of incomplete excision should stimulate close colposcopic and cyt-ologic follow-up to identify the small number of women with residual CIN after therapy.