Completeness of excision and follow up cytology in patients treated with loop excision biopsy

Aims-To assess the relation between the grade and the status of follow up c ytology, the completeness of loop excision biopsies with cervical intraepit helial neoplasia (GIN), and the findings at follow up cytology, as well as the differences between complete and incomplete exclusion, using the odds r atio. Treatment failure was assessed. Methods-1600 women with! GIN (290 CIN1, 304 CIN2, 1006 CIN3) were followed for a minimum of six months and a maximum of 10 years. A database was creat ed and comparisons performed. The mean age of the patients was 37 years. Results-Excision was complete in over 84% of loops. Residual disease and re currence of high grade dyskaryosis was more common in women with CIN 3 than CIN 2 or 1. No high grade: dyskaryosis was seen in the fifth follow up sme ar in patients with GIN 1 and CIN 2. Residual, recurrent, and persistent di sease was most common in patients with incompletely excised CIN at ectocerv ical and endocervical margins and deep margins of resection than in patient s with completely excised GIN. The odds ratios were significantly higher in the women who had incomplete excision of GIN at ectocervical, endocervical , both ecto- and endocervical, and deep margins of resection compared with those with apparent complete excision of GIN lesions. One patient developed invasive squamous cell carcinoma 44 months after loop excision which showe d CIN 3 invading endocervical crypts and extending to both ectocervical and endocervical margins of resection. Conclusions-At long term follow up, patients with CIN who have residual dis ease are at increased risk of persistent disease and should therefore be fo llowed up regularly with cytology and colposcopy. The findings support nati onal policy of returning women with treated GIN of any grade to normal reca ll after five years except for cases of CIN3 where excision was incomplete or equivocal. In these cases follow up with annual smear for 10 years is re commended.