Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town
Date
2022-11
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background
Large loop excision of the transformation zone (LLETZ) has become widely accepted
as the technique of choice for the treatment of cervical intraepithelial neoplasia.
Despite its high efficacy in preventing cervical cancer, variable rates of post-LLETZ
residual/recurrent high-grade squamous intraepithelial lesion (HSIL), also known as
treatment failure is reported globally. This study was conducted to determine the
prevalence of treatment failure within two years of LLETZ treatment for HSIL at
Tygerberg hospital.
Aim
To determine the proportion of women treated for high-grade cervical intraepithelial
neoplasia who developed cytological HSIL within two years of LLETZ.
Materials and Methods
In this retrospective cohort study, the electronic medical records of the first 139
consecutive women who underwent LLETZ treatment in 2016 and had a final
diagnosis of HSIL as well as at least one follow-up cytology within two years of LLETZ
were reviewed.
Setting: Tygerberg Hospital colposcopy clinic, one of two tertiary referral hospitals
in Cape Town, South Africa.
Results: The rate of recurrent HSIL at the first follow-up cytology after LLETZ was
17.3% (95% confidence interval [CI] 11.4 to 24.6). 68.3% of study participants had a
normal cervical cytology at the first follow-up visit after LLETZ. LLETZ margins were
positive for CIN2/CIN3 in 58.3% (81/139) of biopsies, with involvement of the
endocervical margin in almost half of these cases. Age 40 and above was significantly
associated with post-LLETZ HSIL recurrence (odds ratio [OR] = 2.7, 95% CI 1.03 to
7.07, p = 0.04). There was nonsignificant increase in the odds of post-LLETZ
residual/recurrent HSIL among women living with HIV, (OR =2.0, 95% CI 0.68 to 6.10,
p = 0.2). Also, a nonsignificant increase in treatment failure was found when cases
with positive margins were compared with those with clear margins (OR = 2.3, 95% CI
0.69 to 7.53, p = 0.18), as well as when uncertain margin status was compared with
clear margin status (OR = 1.27, 95% CI 0.20 to 8.10, p = 0.80). 16.7% (4/24) of
treatment failure occurred among women with clear LLETZ margins, and no treatment
failure was detected at follow-up when the ectocervical margin was the only involved
margin. The rate of loss to follow-up for a second cytology within two years of LLETZ
was 74.8%.
Conclusions: Even though LETTZ is an effective modality for the treatment of CIN,
one in six treated women develop treatment failure within two years of LLETZ. Women
aged 40 and above at the time of LLETZ are at a higher risk of developing treatment
failure. There is a high rate of loss to follow-up for a second cervical cytology in the
study population.
Key words: High grade squamous intra-epithelial lesion, large loop excision of the
transformation zone, LEEP, residual, recurrent, cervical intraepithelial neoplasia,
margin status, complete excision, recurrent, treatment failure, post-treatment disease.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MMed) -- Stellenbosch University, 2022.
Keywords
Precancerous conditions -- South Africa -- Cape Town, Cervix uteri -- Diseases -- South Africa -- Cape Town, Colposcopy -- South Africa -- Cape Town, Cervical intraepithelial neoplasia -- South Africa -- Cape Town, Squamous cell carcinoma -- South Africa -- Cape Town, UCTD