Impact of Excision Type, Cone Volume, and Dimensions on Persistence/Recurrence of Cervical Intraepithelial Neoplasia 2–3

TL;DR

This study found that a specific type of excision for cervical cancer precursors is linked to fewer recurrences and better outcomes.

Contribution

The study identifies type 3 excision as more effective in reducing CIN2–3 recurrence compared to other excision types.

Findings

Type 3 excision had the lowest recurrence rate (2.1%) compared to type 1 (6.5%) and type 2 (5.4%).

Type 3 excision showed higher clear margin rates (69.6%) and lower HR-HPV positivity (11.4%).

Clear margins and HR-HPV status were significantly associated with excision type.

Abstract

The objective of this study was to evaluate the relationship between the excision type and the persistence/recurrence of CIN2–3. A total of 227 women with CIN2–3 who were treated with LLETZ were evaluated. The types of excision according to the IFCPC 2011, volume, cone dimensions, margins of resection, post-cone high-risk human papillomavirus (HR-HPV) status, and viral load were studied. The time to recurrence was assessed using Kaplan–Meier curves. Persistent/recurrent CIN2–3 was found in 12 cases (5.2%). Type 1 excision was performed in 107 patients, with 7 recurrences (6.5%); type 2 excision in 74 patients, with 4 recurrences (5.4%); and type 3 excision in 46 patients, with 1 recurrence (2.1%). The percentage of clear margins in type 1 excisions was 44.9%, that in type 2 excisions was 59.5%, and that in type 3 excisions was 69.6% (p = 0.008). Type 1 excision was associated with 28.5% post-LLETZ HR-HPV positivity, that in type 2 reached 20.6%, and that in type 3 reached 11.4%; this difference was non-significant (p = 0.24). (4) Conclusions: Type 3 excision was associated with a larger proportion of clear margins and lower post-cone HR-HPV positivity, with a lower incidence of the persistence/recurrence of CIN2–3.

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