Evaluation of Residual Lesions Following Conservative Treatment of High Grade Cervical Intraepithelial Neoplasia СIN2+

Abstract

The purpose of this study was to determine the diagnostic
value Pap smear test and colposcopy in Georgian National
Screening Center, evaluation of efficiency of the excisional treatment and determining the main risk factors for prediction of residual/recurrent disease in patients with highgrade cervical intraepithelial neoplasia. We retrospectively
analyzed 613 patients , who underwent excisional treatment of the cervix (LEEP). Follow-up was performed by
Pap smear test, colposcopy and histamorphological examinations. Accuracy of Pap smear test and colposcopy prior
to the the excisional treatment revealed Pap : Se 83.4%;
Sp 76.4%; PPV 72.6%; NPV76.8%; Colposcopy : Se
83.4%; Sp 69.4%; PPV 69.3 % ; NPV 80.6 %; After the
excisional treatment: Pap :Se 82.8 %; Sp 92.3 %; PPV
61.5 %; NPV 97.3 %; Colposcopy : Se 62.1%; Sp 80.4 %;
PPV 32.1 %; NPV 93.4%. After LEEP colposcopy is less
sensitive than before LEEP. After LEEP sensitivity of the
Pap smear test exceeds the sensitivity of the colposcopy.
Forty one (18.4%) of 223 patients had residual/recurrent
lesion during follow-up. According to univariate analysis
the patient’s age ≥ 40 years (p<0.01) OR 3.2 (95% CI 1.3-
8.4), transformation zone type III (p<0.01) OR 5.0 (95%
CI 2.1-11.5), endocervical gland involvement (p<0.01)
OR 6.2 (95%CI 2.7 - 15.1 ), smoking status (p<0.001) OR
7.7 (95% CI 3.336-17.8), major abnormal cytology
(p<0.05) OR 2.72 (95% CI 0.963-9.512) were significant
risk factors for residual/recurrent disease. However, gravidity, parity, severity of disease and positive margins
were not relevant factors for the residual/recurrent disease
(P>0.05). Consideration and implementation of these predictive factors in patient surveillance protocol will allow
avoiding delayed treatment or overtreatment.