Tumor Persistence in High Grade Squamous Intraepithelial Lesion Patients with Positive Surgical Margin Post Loop Electrosurgical Excision Procedure
Arunee Sankasem MD*, Thaovalai Thavaramara MD*, Sumonmal Manusirivithaya MD*, Siriwan Tangjitgamol MD*
Affiliation : * Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital
Objective : To determine the rates of persistent and recurrent tumors in patients with High Grade Squamous
Intraepithelial Lesion (HSIL) who had positive surgical margin from Loop Electrosurgical Excision Proce-
dure (LEEP)
Materials and Methods : Clinical and pathological data of all women who underwent LEEP procedures and
revealed HSIL lesions with positive surgical margin between July 1997 and December 2004 were recorded.
Results : Histologic diagnoses of HSIL with positive surgical margin were found in 95 cases during the study
period. Residual diseases were identified at ectocervical margins in 46 cases (48.4%), endocervical margin in
26 cases (27.4%), and both margins in 23 cases (24.2%). Subsequent hysterectomy was performed in 58 cases
(61.0%). The remaining 37 cases (38.9%) underwent periodic follow-up with the median follow up period of
11 months (range, 1 -74 months). Persistent diseases were identified in 18 of 58 hysterectomized cases but
none in 37 follow-up cases. Recurrent disease was identified in only one case in the follow-up group. Overall
the rates of persistent and recurrent disease were found in 18.9% and 1.1% respectively.
Conclusion : In HSIL patients with positive surgical margin from LEEP, the rate of persistent disease was
18.9%, while the rate of recurrence was 1.1%.
Keywords : HSIL, LEEP (loop electrosurgical excision procedure), Positive margin, Persistence, Recurrence
