KEY TAKEAWAYS
- The study aimed to investigate the combined influence of ECC findings and surgical margin status on the risk of recurrent cervical dysplasia after LLETZ.
- Researchers found that positive ECC and cranial R1 margins during LLETZ for HSIL greatly increase recurrence risk, emphasizing the need for closer monitoring.
Cervical cancer often originates from cervical cell dysplasia, a precursor lesion that can progress to malignancy if left untreated. Previous studies have primarily focused on the role of surgical margins and the persistence of high-risk human papillomavirus (HPV) in predicting recurrence.
The significance of positive findings from endocervical curettage (ECC) during excision treatments like large loop excision of the transformation zone (LLETZ) has gained increasing attention. Despite this, the combined impact of ECC status and surgical margin involvement on the risk of recurrent dysplasia remains underexplored.
Anne Cathrine Scherer-Quenzer and the team aimed to assess the combined influence of ECC findings and endocervical surgical margins on the likelihood of dysplasia recurrence, the need for re-surgery, and the occurrence of abnormal Pap smears in patients who underwent LLETZ for high-grade squamous intraepithelial lesions (HSIL).
They performed an inclusive analysis of data from 404 patients with HSIL who underwent LLETZ. The study involved a retrospective review of hospital records, focusing on histopathological findings from ECC, the status of endocervical margins, and the orientation of residual disease following LLETZ.
Additionally, researchers evaluated the recurrence or persistence of dysplasia after surgical treatment and the necessity for repeated surgical interventions, including LLETZ or hysterectomy. The collected data provided insights into the combined influence of ECC findings and endocervical margin status on patient outcomes.
The patients with cranial (endocervical) R1-resection combined with HSIL cells in the ECC underwent re-surgery 17 times. Statistically, this outcome was expected in only 5 cases, demonstrating a significant deviation from normal distribution (P < 0.001). Fisher’s exact test confirmed a statistically significant association between the resection status, combined with the ECC results, and the recurrence of dysplasia following surgery (P < 0.001).
Notably, 40.6% of patients who experienced re-dysplasia after the primary LLETZ procedure had both cranial R1-resection and HSIL cells in the ECC. When assessing the risk for future abnormal Pap smears, patients with cranial R1-resection and dysplastic cells in the ECC showed the highest deviation from the statistical normal distribution, with a standardized residual (SR) of 2.6.
The study concluded that the future risk of re-dysplasia, re-surgery, and abnormal Pap smears is significantly higher in patients who had cranial (endocervical) R1-resection combined with HSIL cells in the ECC during their primary LLETZ. These findings suggest that the identification of patients who may benefit from intensified observation or require further intervention could be substantially improved by considering both ECC and surgical margin status in post-LLETZ management.
The study received open-access funding from Projekt DEAL.
Source: https://pubmed.ncbi.nlm.nih.gov/39169335/
Scherer-Quenzer AC, Findeis J, Herbert SL, et al. (2024). “The value of endocervical curettage during large loop excision of the transformation zone in combination with endocervical surgical margin in predicting persistent/recurrent dysplasia of the uterine cervix: a retrospective study.” BMC Womens Health. 2024;24(1):461. Published 2024 Aug 21. doi:10.1186/s12905-024-03291-w
