RESIDUAL AND RECURRENT DISEASE AFTER LASER CONIZATION FOR CERVICAL INTRAEPITHELIAL NEOPLASIA

Objective: To assess the risk of residual and recurrent disease after carbon dioxide laser conization treatment for high-grade lesions of th e cervix uteri, and thus to refine intervals for follow-up. Methods: T he study population comprised all women treated for cervical intraepit helial neoplasia grade II-III over a 10-year period (1983-1992). All w omen who resided within the county for the entire follow-up period wer e followed for residual or recurrent disease, verified histologically until the closure date of January 31, 1996. The cumulative incidence o f recurrent disease was assessed by survival analyses, and logistic re gression was used to predict clinical features at initial treatment th at were associated with the risk of residual or recurrent disease. Res ults: Only 19 of 1081 women (1.8%) were lost to follow-up. Residual di sease was diagnosed in 20 (1.9%) study participants. The cumulative in cidence of recurrent disease was extremely low, increasing nearly line arly with an annual incidence of three per 1000 woman-years observed. Involved resection margins were associated significantly with both res idual disease (crude odds ratio [OR] 18.1; 95% confidence interval [CI ] 5.2, 64.0) and recurrent disease (adjusted OR 3.0; 95% CI 1.2, 7.5) when compared with disease-free resection margins as reference. Conclu sion: We recommend a differential follow-up interval depending upon th e histologic evaluation of cone margins. If there is no residual disea se, women who have free resection margins should return at a 3-year in terval for follow-up. Women who have disease extended to the cone marg ins are recommended Papanicolaou smears at annual intervals through th e fourth postoperative year before returning at a 3-year interval as p racticed in the general screening program. ((C) 1997 by The American C ollege of Obstetricians and Gynecologists).