Cervical intraepithelial neoplasia outcomes after large loop excision withclear margins

Objective: To identify risk factors for residual or recurrent cervical intr aepithelial neoplasia (CIN) after large loop excision of the transformation zone with clear margins. Methods: We did a case-control study of women treated with loop excision fo r CIN who had adequate follow-up and in whom margins were believed to be cl ear. Women with clear margins in whom no subsequent lesions were found (con trols) were compared with women who presented with subsequent CIN (cases). Epidemiologic and colposcopic risk factors for recurrence were analyzed. Mu ltiple logistic regression analysis was done to identify independent risk f actors. Results: In 31 of 635 women studied (4.9%), subsequent lesions were diagnos ed. Univariate analysis identified glandular involvement, satellite lesions , and age over 40 years in cases as significant. Multiple logistic regressi on analysis confirmed that these three characteristics were independent ris k factors, with odds ratios of 4.9 (95% confidence intervals 1.9, 12.3), 19 (7.5, 48.2), and 6.7 (2.8, 15.8), respectively. Subsequent lesions were id entified by colposcopy or cytologic testing during the first postoperative year in all but one case. Conclusion: Age over 40 years, glandular involvement, and satellite lesions were related to the reappearance of CIN after loop excision with clear mar gins. These findings could be used to define appropriate follow-up protocol s. (Obstet Gynecol 2000;95:828-31. (C) 2000 by The American College of Obst etricians and Gynecologists).