The Loop Electrosurgical Excision Procedure (LEEP) is the mainstay technique for the treatment of high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia (SIL/CIN). The use of colposcopy during LEEP improves the accuracy of treatment and reduces the risks of the procedure. However, its possible benefits in relation to the identification of patients with no lesion at the time of LEEP have not been established. The aim of the study was to assess the accuracy of colposcopy evaluation at the time of the LEEP to identify women with a previous confirmatory diagnosis of SIL/CIN with the absence of dysplasia in the cone specimen.
We prospectively recruited 162 women undergoing LEEP for histological HSIL/CIN2-3 or LSIL/CIN1 with HSIL cytology showing a fully visible squamocolumnar junction in the colposcopy evaluation at the time of LEEP. At the referral visit cervical cytology, human papillomavirus (HPV) detection and genotype identification, digital colposcopy, size of the colposcopical lesion, and one or more biopsies of the transformation zone were obtained. The uterine cervix was colposcopically evaluated intraoperatively.
Thirty-four women (21.0%) had a normal colposcopy evaluation at the time of the LEEP (study group), while the remaining 128 women showed abnormal findings (control group). Absence of SIL/CIN in the LEEP specimen was confirmed in 28 of the 34 (82.3%) women in the study group and 8 of the 128 (3.1%) women of the control group (p<0.001). A normal colposcopy evaluation at the time of LEEP, lesion size ≤12mm² at the referral colposcopy and HPV genotypes other than 16 or 18 were associated with the absence of CIN in the univariate logistic regression, but only a normal colposcopy evaluation remained significant in the multivariate analysis. A normal colposcopic evaluation at the time of LEEP increased the risk of absence of lesion in the cone specimen 229-fold compared with cases presenting an abnormal colposcopy (95%CI: 33.8-1555.1; p<0.001). The colposcopy evaluation at the time of LEEP had a sensitivity of 87.5% (95%CI: 71.9-95.0) and a specificity of 95.4% (95%CI: 90.3-97.9) to predict the absence of SIL/CIN in the LEEP specimen.
These data show that colposcopy evaluation at the time of LEEP can accurately identify the absence of SIL/CIN before treatment. Thus, the performance of excisional procedures for the treatment of SIL/CIN under direct colposcopy vision should be recommended. Moreover, small lesions and HPV types other than 16 and 18 may point to patients with a higher probability of having a normal colposcopy evaluation at the time of treatment, indicating which women can forgo the treatment.
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