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Original ArticleOpen Access
Predictive Factors for Residual Disease in the Uterine Cervix after Large Loop Excision of the Transformation Zone in Patients with Cervical Intraepithelial Neoplasia III
Hamontri S 
,
Israngura N ,
Rochanawutanon M ,
Bullangpoti S ,
Tangtrakul S
,
Israngura N ,
Rochanawutanon M ,
Bullangpoti S ,
Tangtrakul S Objective: To determine predictive factors for residual disease in uterine cervix after large loop excision of the
transformation zone (LLETZ) in patients with cervical intraepithelial neoplasia III (CIN III).
Material and Method: Medical records of patients who underwent LLETZ with CIN III between September 1,
1992 and December 31, 2001 in Ramathibodi Hospital were reviewed. Demographic data, colposcopic
findings, and pathologic parameters were analyzed to identify the predictive factors for residual disease in
uterine cervix.
Results: The total of 541 cases were enrolled in this study. Managements after LLETZ are 1) repeated LLETZ,
2) hysterectomy, and 3) Papanicolaou smear. Residual disease was detected in a total of 156 patients (28.84%),
there were 21 cases of CIN I (13.46%), 22 cases of CIN II (14.10%), 107 cases of CIN III (68.59%), and 6
(3.85%) cases of microinvasive squamous cell carcinoma of cervix. 1) Age > 50 years old was significant
factor associated with residual disease. The incidence of residual disease was 50.00%. 2) Unsatisfactory
colposcopy was significant factor associated with residual disease with 38.44% incidence of residual disease.
3) Margins involvement of LLETZ specimen was the only pathological predictive factor identified. The incidence
of residual disease with clear margin, endocervical margin, ectocervical margin, and both margins involvement
were 14.74, 52.63, 57.14, and 74.19% respectively. Other parameters, including gravidity, parity, menopausal
status, cervical gland involvement, and number of quadrants involvement were not predictive of residual
disease.
Conclusion: 1) Age > 50 years old, 2) unsatisfactory colposcopy, and 3) margins involvement of LLETZ
specimens were the predictive factors for residual disease in uterine cervix.
Keywords: CIN III, LLETZ, Residual disease
transformation zone (LLETZ) in patients with cervical intraepithelial neoplasia III (CIN III).
Material and Method: Medical records of patients who underwent LLETZ with CIN III between September 1,
1992 and December 31, 2001 in Ramathibodi Hospital were reviewed. Demographic data, colposcopic
findings, and pathologic parameters were analyzed to identify the predictive factors for residual disease in
uterine cervix.
Results: The total of 541 cases were enrolled in this study. Managements after LLETZ are 1) repeated LLETZ,
2) hysterectomy, and 3) Papanicolaou smear. Residual disease was detected in a total of 156 patients (28.84%),
there were 21 cases of CIN I (13.46%), 22 cases of CIN II (14.10%), 107 cases of CIN III (68.59%), and 6
(3.85%) cases of microinvasive squamous cell carcinoma of cervix. 1) Age > 50 years old was significant
factor associated with residual disease. The incidence of residual disease was 50.00%. 2) Unsatisfactory
colposcopy was significant factor associated with residual disease with 38.44% incidence of residual disease.
3) Margins involvement of LLETZ specimen was the only pathological predictive factor identified. The incidence
of residual disease with clear margin, endocervical margin, ectocervical margin, and both margins involvement
were 14.74, 52.63, 57.14, and 74.19% respectively. Other parameters, including gravidity, parity, menopausal
status, cervical gland involvement, and number of quadrants involvement were not predictive of residual
disease.
Conclusion: 1) Age > 50 years old, 2) unsatisfactory colposcopy, and 3) margins involvement of LLETZ
specimens were the predictive factors for residual disease in uterine cervix.
Keywords: CIN III, LLETZ, Residual disease
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