Long-term cytological and histological outcomes in women managed with loop excision treatment under local anaesthetic for high-grade cervical intraepithelial neoplasia.

OBJECTIVE This study examines the impact of excision margin status after large loop excision of the transformation zone (LLETZ) under local anaesthetic for high-grade cervical intraepithelial neoplasia (HG-CIN) on the cytological and histological outcomes up to 5 years after treatment. METHODS   Prospective cytological and histological data were obtained by examination of the colposcopy database at Addenbrooke's Hospital, Cambridge, UK. All women aged between 19 and 50 years who underwent treatment for HG-CIN by LLETZ under local anaesthetic were included in the study. Patients without follow-up data were excluded from the study. The excision margin status was correlated with the subsequent cytological and histological outcomes. RESULTS A series of 967 women with CIN2 and CIN3 underwent LLETZ excision under local anaesthetic. Overall, 42% of women had disease present at the excision margin following LLETZ. Women with CIN3 were more likely than those with CIN2 to have an involved excision margin (P<0.0001). Cytological recurrence was highest at 12 months (16%) and did not correlate with the CIN grade or excision margin status. Histological recurrence/persistence was also highest at 12 months follow-up (15%) and this correlated with grade of CIN and margin status (P<0.0001). CONCLUSIONS Histological recurrence/persistence correlates with grade of CIN and excision margin status. Management of HG-CIN in an outpatient setting under local anaesthetic is safe, cost effective and yields a favourable long-term outcome.