Can More Detailed Evaluation of Excision Margins Refine Cytological Follow up of Women Post LLETZ Excision of High-Grade Dysplasia?
A Treacy, D Devaney, NJ Mulligan, W Boyd, JC O Keane. Mater Misericordiae University Hospital, Dublin, Ireland; Rotunda Hospital, Dublin, Ireland
Background: The relationship between dysplastic changes in the cervical epithelium and progression to in-situ carcinoma and invasive carcinoma has been extensively studied. Removal of dysplastic epithelium via long loop excision of the transformation zone (LLETZ) in 95% of cases is curative. Between 18-37% of LLETZ specimens with dysplasia at the margins have been shown to have recurrent / residual disease. Previous small studies suggest the degree of dysplasia at margins could predict recurrence and allow risk-based stratification of follow-up (Cardosa-Favarato et al. Human Path Vol. 38; 5: 781-786). We tested this hypothesis in a large group of women post LLETZ with follow up histology and cytology.
Design: All LLETZ specimens containing high-grade dysplasia (CIN2 & CIN3) from the Mater Misercordiae University Hospital over a 12 year period (1995 2007) were reviewed. Follow up cytology and histology results were collected. All cases with a prior LLETZ, glandular intraepithelial neoplasia, invasive cervical carcinoma or subsequent hysterectomy were excluded. The cases were divided into two groups according to excision margin status; negative margins or positive margins. The groups were compared to assess if the LLETZ specimens' margin status had an impact on subsequent cytology or histology results. Positive follow-up results were defined as any grade of dysplasia in cytology or histology.
Results: 2321 women had LLETZs containing high-grade dysplasia over the 12-year period. 1534 (66.1%) had full histology and cytology follow up available. 820 (53.4%) of the LLETZ specimens had positive margins and 714 (46.6%) had negative margins. Grade of dysplasia at margins was available in 796 cases (97%). 170 (20%) of specimens with positive margins had positive follow up results compared with 105 (14.7%) of specimens with negative margins. Detailed results were as follows:
Follow Up Cytology & Histology Results
|Margin Status||Positive Follow Up||Negative Follow Up|
|Positive Margin: CIN 3||77||293|
|Positive Margin: CIN 2||64||246|
|Positive Margin: CIN 1||22||94|
Conclusions: The presence of dysplasia at a LLETZ margin is associated with dysplasia on follow-up cytology and histology (P=0.0021), however the grade of dysplasia at the excision margin is not predictive of recurrent / residual dysplasia.
Monday, March 9, 2009 1:00 PM
Poster Session II # 152, Monday Afternoon