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Long-term follow-up after large-loop excision of the transformation zone: evaluation of 22 years treatment of high-grade cervical intraepithelial neoplasia


Address correspondence and reprint requests to: Dennis van Hamont, MD, MSc, Department of Obstetrics and Gynaecology, Radboud, University Nijmegen Medical Centre, P.O. Box 9101,6500 HB Nijmegen, The Netherlands. Email:


Early treatment of cervical intraepithelial neoplasia (CIN) significantly reduces the risk of invasive cancerous progression. Residual and recurrent high-grade CIN should be detected and retreated in an early phase. Therefore, a postsurgery cytologic follow-up protocol was introduced at 3, 6, 9, and 12 months and yearly thereafter for 5 years. The aim of this study is to evaluate the long-term experience in treating high-grade CIN using large-loop excision of the transformation zone (LLETZ). Additionally, the long-term follow-up in this study gains the opportunity to document the pattern of disease recurrence beyond 5 years. The average follow-up of the 1696 women included in this study was 6.5 years. Overall, 8.5% of the patients who underwent LLETZ showed a high-grade repetitive CIN and three patients had invasive carcinoma. Eighty percent of those lesions were probably residual, whereas 20% of all high-grade repetitive lesions appeared more than 2 years after initial surgery and were considered recurrent lesions. Half of the recurrent lesions occurred more than 5 years after LLETZ.