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Risk Factors of Post-Large Loop Excision of the Transformation Zone Recurrent High-Grade Cervical Intraepithelial Lesion

A Prospective Cohort Study

Demarquet, Emilie, MD1; Mancini, Julien, MD, PhD2,3; Preaubert, Lise, MD, PhD1; Gondry, Jean, MD, PhD4; Chevreau, Julien, MD4; Lamblin, Gery, MD5; Lebail, Karine, MD5; Lavoué, Vincent, MD, PhD6; Pinsard, Marion, MD6; Baldauf, Jean-Jacques, MD, PhD7; Bryand, Angélique, MD7; Henno, Sebastien, MD8; Agostini, Aubert, MD, PhD9; Douvier, Serge, MD, PhD10; Jarniat, Adelaïde10; Riethmuller, Didier, MD, PhD11; Mendel, Anne, MD11; Brun, Jean-Luc, MD, PhD12; Rakotomahenina, Hajanirina, MD12; Carcopino, Xavier, MD, PhD1

Journal of Lower Genital Tract Disease: January 2019 - Volume 23 - Issue 1 - p 18–23
doi: 10.1097/LGT.0000000000000423
Original Research Articles: Cervix and HPV

Objective The aim of the study was to identify the risk factors of post-large loop excision of the transformation zone (LLETZ) recurrent disease and the impact of colposcopic guidance at the time of LLETZ on that risk.

Materials and Methods From December 2013 to July 2014, 204 patients who had undergone LLETZ for the treatment of high-grade intraepithelial lesion with fully visible cervical squamocolumnar junction were included. The use of colposcopy during each procedure was systematically documented. The dimensions and volume of LLETZ specimens were measured at the time of the procedure before formaldehyde fixation. All participants were invited for a follow-up. The primary endpoint was the diagnosis of post-LLETZ recurrent disease defined as the histologic diagnosis of a high-grade cervical intraepithelial lesion.

Results The median duration of post-LLETZ follow-up was 25.8 months. Recurrent disease was diagnosed in 8 (3.6%) patients. Older than 38 years (adjusted hazard ratio [aHR] = 11.9, 95% CI = 1.6–86.0), history of excisional therapy (aHR = 21.6, 95% CI = 3.5–135.3), and the absence of colposcopy for the guidance of LLETZ (aHR = 6.4, 95% CI = 1.1–37.7) were found to significantly increase the risk of post-LLETZ recurrent disease. The dimensions and volume of the specimen were not found to have any impact. Only positive endocervical margins were identified to significantly increase the risk of post-LLETZ recurrent disease (aHR = 14.4, 95% CI = 2.0–101.1).

Conclusions Risk factors of post-LLETZ recurrent disease are older than 38 years, history of excisional therapy, positive endocervical margins, and lack of colposcopic guidance at the time of LLETZ.

1Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France;

2Aix Marseille University, Inserm, IRD, UMR S1252, SESSTIM, Marseille, France;

3APHM, Hôpital de la Timone, Public Health Department, BioSTIC, Marseille, France;

4University Hospital of Amiens, Jules Verne University, Picardie, France;

5Department of Obstetrics and Gynaecology, Femme Mère Enfant University Hospital, Lyon-Bron, France;

6Teaching hospital of Rennes, Gynaecologic Department, University of Rennes 1, Rennes, France;

7Department of Obstetrics and Gynaecology, Hospital of Hautepierre, Strasbourg University Hospitals, Strasbourg, France;

8Department of Pathology, CHU Pontchaillou, Rennes, France;

9Department of Obstetrics and Gynaecology, Hôpital La Conception, APHM, Aix-Marseille University (AMU), Marseille, France;

10Department of Gynaecologic and Oncologic Surgery, CHU Dijon, France;

11Pôle Mère-Femme, University Hospital Jean Minjoz, Besançon, France; and

12Pôle d'Obstétrique Reproduction Gynécologie, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, Bordeaux, France

Reprint requests to: Xavier Carcopino, MD, PhD, Department of Obstetrics and Gynaecology, Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France. E-mail:

The authors have declared they have no conflicts of interest.

The study protocol received institutional approval from the ethics committee of the French College of Obstetricians and Gynecologists, Paris, France (CEROG 2013-GYN-1001).

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology