Value Of Loop Electrosurgical Excision Procedure For Cervical Intraepithelial Neoplasia And High Risk HPV Test In Detection Of Residual And Recurrent Disease Following LEEP

Objectives :To investigate the clinical value of loop electrosurgical excision procedure (LEEP)for management of cervical intraepithelial neoplasia (CIN) and to evaluate the value of high risk human papillomavirus(HR-HPV) test in detection of residual and recurrent disease following LEEP.Methods: A series of 104 CIN including 34 CIN1, 43 CIN2 and 27 CIN3, who were preliminarily diagnosed by cervical cytological examination, colposcopy and biopsy under the colposcopy, were subjected to LEEP between January 2006 and August 2007. The operation time ,the blood loss and postoperative outcomes were observed.The last diagnosis was the pathological higher one of biopy and LEEP.Two months after LEEP bleeding, discharge, and repair were observed every 2～4 weeks. Three months, 6 months and longer time than 6 month after LEEP was followed-up biannually. The follow-up methods included cytology, colposcopy and HR-HPV. The abnormal cytological or colposcopy findings were further biopsied under the colposcopy. Presence of histologically confirmed CIN was considered as residual or recurrent disease. HR-HPV testing was realized by Hc2 before and 6 months after LEEP in 102 cases.Results: The mean operation time was 6.03±2.86 min (3.00～30.00 min) and the average blood loss was 10.06±3.10 ml(5.00～50.00ml). The pathological diagnosis after LEEP showed: 15 inflammation, 25 CIN1, 29 CIN2 , 34 CIN3 and 1 early cervical microinvasive carcinoma.The preoperative pathological diagnosis of 69 cases (66.35%) were consistent with that of the postoperative ones.And 35cases (33.65%)were not consistent .The postoperative grade was lowered in 23(21.11%) and was elevated in 12(11.54%). Except for one microinvasive cancer and one case treated by hysterectomy , the 102 cases were followed up for at least 6 months. The postoperative complication rate was 3.85%(4/104)and the main complication was bleeding(2.94%). The primary overall cure rate was 92.16%(94/102). Six residual diseases(5.88%) and two recurrences(1.96%) were observed. Of these cases, 82 ones (80.39%) were positive for HR-HPV testing before LEEP and 19 ones(18.63%) after LEEP. The HR-HPV positive rate in CIN 2 and CIN3 were significantly higher than that in CIN 1 before and after LEEP(P<0.05).But there was no statistically significant difference in the positive rate between CIN 2 and CIN 3(P>0.05). There was no correlation between pretreatment HR-HPV testing and the residual disease or recurrence(P>0.05). Residual and recurrent disease were more likely to occur when the posttreatment HR-HPV test was positive(P<0.05). At 6 months after operation, sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of TCT in predicting residual and recurrent diseases were 100%, 84.04%, 34.78%, 100 % respectively; that of HR-HPV in predicting residual and recurrent diseases were 100%, 88.30%, 42.11%, 100 % respectively. HR-HPV and TCT showed similar sensitivity and NPV as alone tests.Conclusions:①LEEP with the value of both diagnosis and therapy is a simple, safe and effective method for treatment of CIN. And it could help to eliminate the infection of HR-HPV.②The HR-HPV positive rate in high grade CIN is higher than that in low grade CIN.③Biopsy under the colposcopy could not replace cervial conization.④Posttreatment HR-HPV detection has important value in predicting the risk of residual and recurrent disease and could be effective in the follow-up after LEEP. The cases who have posttreatment HR-HPV persistent infection should be followed frequently.