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Clinical Significance of a Negative Loop Electrosurgical Excision Procedure Biopsy in Patients With Biopsy-Confirmed High-Grade Cervical Intraepithelial Neoplasia

Nam, Kyehyun MD, PhD; Ryu, Aeli MD; Jeon, Seob MD, PhD; Kim, Jeongsig MD, PhD; Kwak, Jeongja MD, PhD; Park, Bora MD

Journal of Lower Genital Tract Disease: April 2015 - Volume 19 - Issue 2 - p 103–109
doi: 10.1097/LGT.0000000000000061
Original Articles: Cervix and HPV

Objective: We sought to determine which clinical factors can predict this phenomenon and to better understand the clinical significance of negative loop electrosurgical excision procedure (LEEP) findings through long-term follow-up.

Methods: We identified 559 patients with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or 3 (CIN 2, 3) who were treated by LEEP between February 2001 and December 2010. Preconization clinical characteristics, as well as high-risk human papillomavirus (hrHPV) status, were analyzed as possible predictors of an absence of a lesion in the specimen. The clinical significance of an absence of a lesion in the specimen, as well as other factors, was evaluated by Cox hazard regression analysis in terms of recurrence.

Results: No lesion on the LEEP specimen was found in 102 (18.2%) of 559 patients with CIN 2,3 on punch biopsy. Punch biopsy status of CIN 2, low HPV viral load (<100 relative light units [RLU]), and negative or positive HPV infection other than type 16 were significantly related to no lesion in the LEEP specimen. Postoperative HPV persistence (≥10 RLU) and same-type HPV detection were significantly related to recurrent disease of CIN 2+ (p < .001). The recurrence of patients with no lesion in LEEP did not statistically differ from that of patients with a lesion in the LEEP specimen (p = .390).

Conclusions: The absence of a lesion in the LEEP specimen is very common. A negative LEEP is associated with a persistence/recurrence rate similar to that of positive LEEP. We recommend that the follow-up for patients with no lesion in the LEEP specimen should be the same as that for patients with a lesion.

Reprint requests to: Kyehyun Nam, PhD, MD, Soonchunhyang University Bucheon-si, Gyunggi-do, Republic of Korea. E-mail:

The author has declared that there are no conflicts of interest.

Kyehyun Nam and Aeli Ryu contributed equally to this work.

Copyright © 2015 by the American Society for Colposcopy and Cervical Pathology