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

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dc.contributor.advisorBotha, Matthys Hendriken_ZA
dc.contributor.authorOlujobi, Victoren_ZA
dc.contributor.otheren_ZA
dc.date.accessioned2022-11-19T12:44:38Zen_ZA
dc.date.accessioned2023-01-16T12:46:17Zen_ZA
dc.date.available2022-11-19T12:44:38Zen_ZA
dc.date.available2023-01-16T12:46:17Zen_ZA
dc.date.issued2022-11en_ZA
dc.descriptionThesis (MMed) -- Stellenbosch University, 2022.en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.af_ZA
dc.description.versionMastersen_ZA
dc.format.extentxi, 32 pages : illustrationsen_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/126024en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subjectPrecancerous conditions -- South Africa -- Cape Townen_ZA
dc.subjectCervix uteri -- Diseases -- South Africa -- Cape Townen_ZA
dc.subjectColposcopy -- South Africa -- Cape Townen_ZA
dc.subjectCervical intraepithelial neoplasia -- South Africa -- Cape Townen_ZA
dc.subjectSquamous cell carcinoma -- South Africa -- Cape Townen_ZA
dc.subjectUCTDen_ZA
dc.titlePrevalence 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 Townen_ZA
dc.typeThesisen_ZA
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