Oncology Medical News about high-grade squamous intraepithelial lesions;free excision margins;routine follow-up

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Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after large lLoop excision of the transformation zone (LLETZ)
Gynecologic Oncology, 06/03/09

Eijsink JJH et al. - In a trial to assess the compliance of high-grade squamous intraepithelial lesions (HSIL) pts to the national Dutch routine follow-up protocol in the first 2 yrs after large loop excision of the transformation zone (LLETZ) and to determine if based on the status of excision margins, follow-up intervals could be modified, it was decided that compliance to the Dutch national routine follow-up protocol in HSIL pts after LLETZ is only moderate. For HSIL pts with free excision margins after LLETZ, the first cytological follow-up interval can safely be increased to 12 mos.

Methods

A study was performed in pts referred because of an abnormal Pap smear and treated for HSIL with LLETZ.
The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 mos, respectively.
Follow-up results were completed by using PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands.
To assess compliance to the follow-up protocol, adequate follow-up was defined as 3 cervical smears taken after 6 (+/-3), 12 (+/-3), and 24 (+/-3) mos, respectively.

Results

Compliance to the first 2 yrs follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second, and third follow-up cervical smears, respectively.
Pts with involved excision margins had a 3 times higher overall risk of developing a subsequent HSIL after LLETZ vs pts with free excision margins.
Risk for diagnosing HSIL during the first 12 mos of follow-up for pts with free excision margins was only 1%.

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