PERSISTENT INTRAEPITHELIAL NEOPLASIA AFTER EXCISION FOR CERVICAL INTRAEPITHELIAL NEOPLASIA GRADE-III

Objective: To determine the factors associated with subsequent intraep ithelial neoplasia among patients who had cervical intraepithelial neo plasia grade III (CIN III) diagnosed on a specimen from previous large -loop excision of the transformation zone. Methods: We studied all lar ge-loop excisions of the transformation zone performed between May 199 1 and December 1993, inclusive. All cases of CIN III were identified. We followed up patients with cytology and colposcopy for 2 years after treatment for high-grade CIN. Findings at follow-up were analyzed. Re sults: A histologic diagnosis of CIN III was made in 225 patients. The lesion appeared incompletely excised in 105 patients (48.2%). In 76 c ases (34.9%), CIN III was found at the endocervical margin. Of the 211 patients reviewed at 6 months, 18 (8.5%) had histologically proven CI N. The incidence of CIN was 16.5% after a report of incomplete excisio n, compared with 1.9% after a report of complete excision (P < .001). Furthermore, there was no subsequent CIN III in the complete-excision group. Of the 183 patients reviewed at 24 months, seven (3.8%) had his tologically proven CIN. All cases of subsequent CIN were associated wi th dyskaryosis on follow-up cervical cytology. Conclusions: Positive m argins increase the risk of treatment failure. Cytology alone may be a dequate for follow-up when CIN III is completely excised. Copyright (C ) 1997 by The American College of Obstetricians and Gynecologist.