Abstract

INCOMPLETE EXCISION OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA AND ITS FOLLOW UP SMEAR

Shankarappa Rashmi* and K M K Shivakumar

Abstract

Objective: To evaluate the follow-up smear of incompletely excised high grade cervical intraepithelial neoplasia (CIN) at large loop excision of transformation zone. Material and Methods: The data collection was from the computer database maintained at the colposcopy clinic, the patient pathway manager and the result server in the hospital. Data was collected for all women who underwent loop excision for CIN 2 or CIN 3 between January 2009 to December 2009 and the histology was reported with positive excisional margins. All women had at least one follow-up smear after the treatment. Results: 249 women had incomplete excision of high grade CIN. 53/249 did not have a follow-up smear, hence excluded from analysis. Ectocervical margin was involved in 91(44%) women of whom 95% had negative smear and 5% had positive smear at follow-up. Endocervical margin was involved in 25 (14%) of whom 88% had negative smear and 12% had positive smear at follow-up . Lateral margin was involved in 27 (12%) of whom 96% and 4% had negative and positive smear respectively . 46 (26%) women had more than one margin involved, 94% had negative and 6% had positive smear at follow-up . In 7 (4%) women the margin was unspecified, 5/7 (72%) had negative smear and 2/7 (14%) had positive smear. Overall 182/196 (90.8%) had negative smear at follow-up following incomplete excision of CIN at various margins and 14/196 (9.2%) women had positive smear. Conclusion: Women with incomplete excision of high grade CIN at LLETZ can be followed up by smear only at first visit and need not require colposcopy at their first followup.

Keywords: Pap smear, colposcopy, follow-up, incomplete excision.