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Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ)

Eijsink, J. J. H., de Bock, G. H., Kuiper, J. L., Reesink-Peters, N., van Hemel, B. M., Hollema, H., Nijman, H. W., Mourits, M. J. E. & van der Zee, A. G. J., Jun-2009, In : Gynecologic Oncology. 113, 3, p. 348-351 4 p.

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Objective. To assess the compliance of HSIL patients to the national Dutch routine follow-up protocol in the first 2 years after LLETZ and to determine if based on the status of excision margins, follow-up intervals could be modified.

Methods. A prospective cohort study was performed in patients, referred because of an abnormal Pap smear between 1996 and 2004 and treated for HSIL with LLETZ. The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 months, respectively. Follow-up results were completed by using PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands. To assess compliance to the follow-up protocol, adequate follow-up was defined as three cervical smears taken after 6 (+/-3), 12 (+/-3) and 24 (+/-3) months, respectively.

Results. Compliance to the first 2 years follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second and third follow-up cervical smears, respectively. Patients with involved excision margins had a three times higher overall risk of developing a subsequent HSIL after LLETZ as compared to patients with free excision margins (HR: 3.2, 95% Cl = 1.3-7.9, p, = 0.01). Risk for diagnosing HSIL during the first 12 months of follow-up for patients with free excision margins was only 1%.

Conclusions. Compliance to the Dutch national routine follow-up protocol in HSIL patients after LLETZ is only moderate. For HSIL patients with free excision margins after LLETZ the first cytological follow-up interval can safely be increased to 12 months. (C) 2008 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)348-351
Number of pages4
JournalGynecologic Oncology
Volume113
Issue number3
Publication statusPublished - Jun-2009

    Keywords

  • High-grade squamous intraepithelial lesion (HSIL), Large Loop Excision of the Transformation Zone (LLETZ), Excision margin, Follow-up, Protocol, Compliance, CYTOLOGIC ABNORMALITIES, INCOMPLETE EXCISION, NEOPLASIA, RISK, METAANALYSIS, RECURRENCE, FAILURE

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