scholarly journals Defining the short-term disease recurrence after Loop Electrosurgical Excision Procedure (LEEP)

2020 ◽  
Author(s):  
Nicholas Papalia ◽  
Amanda Rohla ◽  
Selphee Tang ◽  
Jill G. Nation ◽  
Gregg Nelson
Keyword(s):  
Laser Ablation ◽  
Disease Surveillance ◽  
Clinical Equipoise ◽  
High Grade ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Record System ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Abstract Background The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing HPV testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP. Methods In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed. Results Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. 31 (14%) were seen in a subsequent visit for abnormal findings. Of these, 7 (3.2%) underwent further treatment for high-grade disease (CIN 2/3). Of the 31, 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. One patient had a repeat LEEP for persistent LSIL. Conclusion In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.

scholarly journals Defining the short-term disease recurrence after Loop Electrosurgical Excision Procedure (LEEP)

2019 ◽  
Author(s):  
Nicholas Papalia ◽  
Amanda Rohla ◽  
Selphee Tang ◽  
Jill G. Nation ◽  
Gregg Nelson
Keyword(s):  
Laser Ablation ◽  
Disease Surveillance ◽  
Clinical Equipoise ◽  
High Grade ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Record System ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Abstract Purpose: The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing HPV testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP. Methods: In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed. Results: Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. Of the 31 (14%) who were seen in a subsequent visit, 7 (3.2%) underwent further treatment for high-grade disease (CIN 2/3). The remaining 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. Conclusion: In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.

scholarly journals Defining the short-term disease recurrence after Loop Electrosurgical Excision Procedure (LEEP)

2019 ◽  
Author(s):  
Nicholas Papalia ◽  
Amanda Rohla ◽  
Selphee Tang ◽  
Jill G. Nation ◽  
Gregg Nelson
Keyword(s):  
Laser Ablation ◽  
Disease Surveillance ◽  
Clinical Equipoise ◽  
High Grade ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Record System ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Abstract PURPOSE: The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing HPV testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP. METHODS: In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed. RESULTS: Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. 31 (14%) were seen in a subsequent visit for abnormal findings. Of these, 7 (3.2%) underwent further treatment for high-grade disease (CIN 2/3). Of the 31, 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. One patient had a repeat LEEP for persistent LSIL. CONCLUSION: In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.

scholarly journals Defining the short-term disease recurrence after Loop Electrosurgical Excision Procedure (LEEP)

2020 ◽  
Author(s):  
Nicholas Papalia ◽  
Amanda Rohla ◽  
Selphee Tang ◽  
Jill G. Nation ◽  
Gregg Nelson
Keyword(s):  
Laser Ablation ◽  
Clinical Equipoise ◽  
Low Grade ◽  
High Grade ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Record System ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Abstract Background The goal of cervical cancer screening is to identify dysplastic lesions for subsequent excision in order to prevent invasive disease. There is clinical equipoise, on how to best follow women for disease surveillance after treatment with some Canadian provinces exclusively performing colposcopy and some utilizing Human Papilloma virus (HPV) testing in addition to cervical cytology. Loop Electrosurgical Excision Procedure (LEEP) is used to treat pre-invasive HPV-mediated disease and patients are typically followed for 12 months after disease excision. This study aims to quantify the prevalence of high-grade disease at the time of the second follow-up colposcopy visit, in a practice setting that utilizes laser ablation in addition to LEEP. Methods In a retrospective cohort study, consecutive patient charts were accessed through the electronic medical record system, ARIA, at the Tom Baker Cancer Centre, in Calgary, Alberta, from January 2010 to December 2015. Data was extracted and a REDCap database was used to compile pertinent information from charts meeting inclusion criteria. Descriptive and analytic statistics were performed. Results Of the 303 patients identified, 221 patients met inclusion criteria. 86% of these patients met discharge criteria from colposcopy after the second follow up visit. 31 (14%) were seen in a subsequent visit for abnormal findings. Of these, 7 (3.2%) underwent further treatment for high-grade disease (Cervical Intraepithelial Neoplasia, CIN 2/3). Of the 31, 23 (10.6%) had a third – negative – visit, resulting in discharge from colposcopy. One patient had a repeat LEEP for persistent Low-Grade Squamous Intraepithelial Lesion (LSIL). Conclusion In summary, our data demonstrates a prevalence of 3.2% of high-grade disease at the time of a second colposcopic follow up visit after treatment, in a setting which frequently utilizes laser ablation in combination with LEEP, for large lesions. This recurrence rate is consistent with most published literature on recurrence rates of CIN2/3.

Recurrence after Treatment by Loop Electrosurgical Excision Procedure (LEEP) of High-Grade Cervical Intraepithelial Neoplasia

2002 ◽  
Vol 88 (6) ◽  
pp. 478-480 ◽  
Author(s):  
Silvia Cecchini ◽  
Carmen Beatriz Visioli ◽  
Marco Zappa ◽  
Stefano Ciatto
Keyword(s):  
Recurrence Rate ◽  
Screening Program ◽  
Intraepithelial Neoplasia ◽  
First Year ◽  
Time Interval ◽  
High Grade ◽  
Independent Association ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Purpose To evaluate the recurrence rate of high-grade CIN treated by loop electrosurgical excision procedure (LEEP) and the optimal follow-up schedule. Method 622 cases of CIN2/3 consecutively treated by LEEP in the Florence screening program, with 66.5 months average follow-up (range, 6–195 months), were evaluated. Recurrence was defined as histological evidence of high-grade CIN. Results The average recurrence rate was 9.1% (52 cases). Recurrence was significantly associated to increasing age (χ2 = 12.73, df = 3, P < 001), CIN grade (10.5 vs 6.1%, χ2 = 3.37, df = 1, P = 0.067), and time interval, with the risk of developing a recurrence highest in the first year (7.4%, 95% confidence interval, 5.3–9.5%.), and rare beyond the third year. Multivariate analysis confirmed a significant independent association of age (particularly over age 40) and CIN grade to the risk of recurrence. Conclusions LEEP is an effective procedure for the treatment of high-grade CIN. Most recurrences after LEEP occur in the first 3 years, and non-recurrent cases at that date may stop intensive follow-up and return to current cytological screening every 3 years.

Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

2018 ◽  
Vol 32 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Amar Miglani ◽  
Joseph M. Hoxworth ◽  
Matthew A. Zarka ◽  
Devyani Lal
Keyword(s):  
Frozen Section ◽  
Standard Of Care ◽  
Inverted Papilloma ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Predictive Values ◽  
Endoscopic Techniques ◽  
Time Of Presentation ◽  
Very High

Background Recurrence of inverted papilloma (IP) is a problem in 12–17% of tumors. Controversy exists regarding benefits of intraoperative frozen section histopathology (IFSH) for IP resection; however, to our knowledge, no study has specifically investigated this. IFSH for IP resection is the standard of care in our practice. We, therefore, reviewed our outcomes of using IFSH for IP resection. A secondary goal was to assess the reliability of IFSH. Methods Patients with IP who underwent surgical resection (2010–2016) with minimum 9–month follow-up were included. Results Twenty-two adults with IP met inclusion criteria. All underwent surgery via endoscopic techniques, supplemented by external ports in five patients. At the time of presentation, 36% IPs were recurrent tumors; 68% were graded as Krouse stage 3. Resection was conducted until “clear” (negative) mucosal margins were achieved on IFSH. In 6 (27%), a “positive” IFSH result dictated additional resection to clear margins. Final negative margins were achieved in all the patients. Both positive and negative predictive values for IFSH were 100% (concordance with final pathology results). Surveillance was performed every 1–6 months with nasal endoscopy by using imaging when necessary. No recurrences were noted (0%) at mean follow-up of 40 months (range, 10 -73 months). Conclusions Positive IFSH results led to increased resection in 27% of the patients, with a 0% recurrence rate in this cohort. The reliability of IFSH for IP is very high. No recurrence of IP was noted in any patient at a mean follow-up of 3.3 years. IFSH may help reduce recurrence rates of IP, but additional studies with longer follow-up are warranted.

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study

2020 ◽  
Vol 159 (3) ◽  
pp. 636-641 ◽  
Author(s):  
Giorgio BOGANI ◽  
Violante DI DONATO ◽  
Francesco SOPRACORDEVOLE ◽  
Andrea CIAVATTINI ◽  
Alessandro GHELARDI ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Follow Up Study ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Ten Year Follow-Up Study of Women Presenting to a Genitourinary Medicine Clinic with Anogenital Warts

1992 ◽  
Vol 3 (1) ◽  
pp. 28-32 ◽  
Author(s):  
J Handley ◽  
H Lawther ◽  
T Horner ◽  
R Maw ◽  
W Dinsmore
Keyword(s):  
Laser Ablation ◽  
Pap Smear ◽  
Low Grade ◽  
High Grade ◽  
Anogenital Warts ◽  
Clinic Attendance ◽  
Cytological Evidence ◽  
Contraceptive Usage ◽  
Cone Biopsy

One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later. Median duration of warts following initial clinic attendance was 2 months (range 0–120 months). In 1979 cervical PAP smear results were available for 76 patients; cervical intraepithelial neoplasia (CIN) was seen in 15/76 (19.7%) women; 3 (4%) women had low grade CIN, 12 (15.7%) women had high grade CIN. Nineteen women had had treatment for CIN between 1979 and 1989, 7 laser ablation, 9 cone biopsy, 2 laser ablation and cone biopsy, and one woman laser ablation, cauterization and cone biopsy. At 10-year follow-up in 1989 4/100 women had anogenital warts, 12/100 women had cytological evidence of CIN (7 low grade, 5 high grade), and 37/100 women had CIN detected on colposcopic biopsy (31 low grade, 6 high grade). No women developed invasive cervical carcinoma during the study period. CIN lesions, detected in 1979, regressed without any treatment in 2 women. Colposcopic biopsy was 3.1 times more sensitive than single cervical PAP smear at detecting CIN (4.4 times as sensitive in detecting low grade CIN; 1.2 times as sensitive in detecting high grade CIN). In 1989 CIN was detected in 7/19 (36.8%) of women who had undergone cervical treatment between 1979 and 1989, and in 35/81 (43.2%) of women having no cervical treatment within this period (chi squared P > 0.5). These findings suggest that cervical laser ablative therapy and cone biopsy do not in the long term influence the natural history of cervical human papilloma virus-associated disease (CIN) in women with anogenital warts. Fifty-three per cent of women had CIN (34% low grade, 19% high grade) at some time during the study period. When considered individually, age at first coitus, number of sexual partners, cigarette smoking habits, oral contraceptive usage, initial duration of warts after first clinic attendance and parity, did not significantly affect the risk of developing CIN.

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