High-grade squamous intraepithelial lesions: abbreviating posttreatment surveillance

Obstet Gynecol. 2004 Mar;103(3):488-92. doi: 10.1097/01.AOG.0000114983.11562.08.

Abstract

Objective: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved.

Methods: Women treated in our dysplasia clinic for high-grade squamous intraepithelial lesions by loop excision between January 1990 and December 1999 were identified. Demographic information, pathologic diagnosis, and follow-up visits were extracted from medical records. Follow-up data included all Papanicolaou (Pap) tests and/or cervical biopsies performed in our clinic after the initial procedure.

Results: Women (n = 705) were treated for biopsy-proven high-grade dysplasia. Of those treated, 526 (74%) had at least 1 follow-up Pap test performed in our clinics within 2 years of their original procedure. During the 2 years of posttreatment surveillance, 70 (13.3%) women demonstrated recurrent cervical intraepithelial neoplasia 2 or 3. Recurrence was highest during the first 6 months and between months 22 and 24 of surveillance. This rate was noted to be dramatically lower during months 7 to 21 of surveillance (P <.001). Increasing age was independently associated with a 1.6-fold per decade (95% confidence interval 1.29, 1.9) increase in risk of recurrence. A negative margin status was independently associated with a 0.29-fold (95% confidence interval 0.17, 0.5) decrease in risk of recurrence. Race was not shown to have an influence on risk of recurrence.

Conclusion: A clinically and financially optimal surveillance schedule for women treated for high-grade dysplasia with loop excision would be to obtain Pap tests every 6 months for 1 year and then return to annual screening. Lengthening the surveillance intervals could be beneficial to patients, while decreasing healthcare costs, without compromising the ability to detect and treat recurrent disease.

Level of evidence: II-2

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Cervical Intraepithelial Neoplasia / pathology*
  • Cervical Intraepithelial Neoplasia / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Monitoring, Physiologic / methods*
  • Monitoring, Physiologic / standards
  • Neoplasm Recurrence, Local / pathology*
  • Papanicolaou Test*
  • Practice Guidelines as Topic
  • Time Factors
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery
  • Vaginal Smears / methods*
  • Vaginal Smears / standards