Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia after large loop excision of transformation zone: Do we need a different follow-up strategy?


Mr Mallikarjun Kodampur, Department of Gynaecological Oncology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SW17EH, UK. Email: mkodampur@doctors.net.uk


Aims:  The aim of this study was to determine the effect of endocervical crypt involvement in specimens with clear margins on recurrence following large loop excision of transformation zone (LLETZ).

Material and Methods:  This was an observational cohort study. In the colposcopy unit in a university teaching hospital we prospectively collected data for women who underwent LLETZ treatment for high-grade cervical intraepithelial neoplasia (CIN) between 2003 and 2004. We determined the difference in recurrence rate and need for repeat treatment between groups with and without crypt involvement in the primary histology. We prospectively collected data of follow up until 2010. The recurrence was analyzed using Cox regression.

Results:  A total of 309 women had complete excision of the margins following LLETZ treatment for CIN 2 or 3. There was no significant difference in age between groups with (30.2) and without (29.7) crypt involvement (P < 0.25). There was a significant difference in the prevalence of abnormal smear results before and after LLETZ between groups with or without crypt involvement (P = 0.043). The need to perform a repeated treatment was significantly different between groups with and without crypt involvement (P < 0.024). A full model significantly predicted recurrence of cervical pathology (P < 0.009) that necessitated treatment when crypt involvement was present. The odds ratio for repeat treatment with crypt involvement was 2.67 (confidence interval, 1.27–5.64).

Conclusions:  Our study showed that positive involvement of endocervical crypt by CIN in a cervical loop excision specimen increases the frequency of subsequent episodes of treatment.