The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease

摘要

Abstract Objective To evaluate the usefulness of endocervical curettage ( ECC ) during loop electrosurgical excision procedures ( LEEP s) in predicting the risk of persistence/recurrence of cervical intraepithelial neoplasia grade 2 or higher ( CIN 2+) and informing clinical decision‐making after LEEP . Methods The present retrospective study included women undergoing LEEP for CIN 2+ at a teaching hospital in Chile between January 1, 2007, and December 31, 2014. Demographic, pathologic, and follow‐up data were collected. Associations between predictors and treatment failure (persistent/recurrent disease) were examined; a Cox model was used to assess the effects of different variables on the failure rate. Results The analysis included 330 women with a mean follow‐up of 29.4?months; 188 women underwent ECC at the time of LEEP . On multivariate analysis, a positive ECC was the only variable significantly associated with persistence/recurrence ( P =0.001). In the Cox model, positive ECC ( P =0.001) and positive margins ( P =0.009) were independently associated with higher failure rates. When faced with positive ECC findings, clinicians tended to perform additional treatment instead of advising follow‐up. Conclusion Positive findings from ECC performed during LEEP were a better predictor of persistent/recurrent disease than margin status, after adjusting the individual variable effect in the Cox modelling. The performance of ECC is recommended during any LEEP performed for CIN 2+; in particular, it should never be omitted if endocervical disease is suspected.