Factors influencing persistence or recurrence of cervical intraepithelial neoplasia after loop electrosurgical excision procedure

Objective.: The purpose of this study was to determine the predictors of persistent or recurrent cervical intraepithelial neoplasia (CIN) after a loop electrosurgical excision procedure (LEEP) procedure in an urban population of low socioeconomic status. Methods.: A database was created using information about LEEPs done between October 2004 and December 2008 at John H. Stroger Jr. Hospital, Cook County. This information was then analyzed using χ test to determine the predictors of persistent or recurrent CIN. Results.: A total of 769 LEEPs were performed during the study period, and 52 were excluded secondary to ineligible entries, index cytology report not recorded, or incorrect medical record numbers. Persistent or recurrent disease was defined as cytology of atypical squamous cells cannot rule out high grade lesion (ASC-H) or worse without a histology, or histology of CIN 1 or worse, at any time after the LEEP was performed. Of our study population, 64.7% had a follow-up cytology or biopsy performed. Of these women, 24.7% had persistent or recurrent disease. The preoperative factors, namely positive human immunodeficiency virus serostatus (p < .0001) and a preoperative endocervical curettage that was positive for neoplasia (p < .0001), and postoperative factors, namely positive margin status (p < .0001) and high-grade pathology on the LEEP specimen (p < .0001), were significantly associated with persistent or recurrent disease. A high-grade preoperative cytology, a high-grade preoperative cervical biopsy, or the type of procedure performed (single specimen or separate endocervical pass) was not significantly associated with persistent or recurrent disease. Conclusions..: In our population, adherence with follow-up was poor, and the rate of persistence or recurrence was high. In a limited resource setting such as ours, patients with significant predictors of persistence/recurrence such as human immunodeficiency virus seropositivity, endocervical disease, and high-grade pathology or positive margins on LEEP specimens should be targeted for closer surveillance.