Outcomes of Patients Undergoing Loop Electrosurgical Excision Procedure for Persistent Low-grade Abnormal Cervical Smears: A Retrospective Observational Study

Abstract

Objective: To review the outcomes of patients undergoing loop electrosurgical excision procedure for persistent low-grade abnormal cervical smear results.
Methods: Data on patients undergoing loop electrosurgical excision procedure for persistent low-grade abnormal cervical smear results from January 2008 to December 2009 at Princess Margaret Hospital, Hong Kong were retrieved from the Hospital Authority Endoscopy Record System. Colposcopic findings, loop electrosurgical excision procedure histology, and patients’ outcomes were reviewed through the Electronic Patient Record system, and the information was supplemented by follow-up telephone calls.
Results: A total of 123 patients were included in the study. The median follow-up duration was 3.6 years. In 87 (70.7%) patients, their follow-up cervical smears became normal after loop electrosurgical excision procedure, while the remaining 36 (29.3%) patients had persistent or recurrent abnormal cervical smear results. Patients aged ≥50 years were significantly more likely to have abnormal cervical smear results after loop electrosurgical excision procedure than those <50 years (50.0 vs. 21.3%, p=0.002). There was no correlation between prior colposcopic biopsy results, loop electrosurgical excision procedure histology, or margin status and recurrence of abnormal cervical smear results. In 13 (10.6%) patients, the final pathology was high-grade lesions (cervical intraepithelial neoplasia 2 or 3). The incidence of high-grade cervical intraepithelial neoplasia was similar in patients with prior colposcopic biopsy results of cervical intraepithelial neoplasia 1 or koilocytosis. The commonest complication was secondary haemorrhage, which occurred in 13 (10.6%) patients.
Conclusions: Loop electrosurgical excision procedure should be offered to women with persistent low-grade abnormal cervical smear results, whether the colposcopic cervical biopsy showed cervical intraepithelial neoplasia 1 or koilocytosis. Follow-up cervical smears after loop electrosurgical excision procedure in patients aged ≥50 years should be reinforced as they are more likely to have subsequent abnormal cervical smear results.