Do fertile women have an inferior treatment for high-grade precancerous lesions?

J Obstet Gynaecol Res. 2018 Apr;44(4):772-777. doi: 10.1111/jog.13582. Epub 2018 Jan 25.


Aim: To investigate whether a concern for future pregnancy is reflected in the extent of large loop excision of the transformation zone (LLETZ) and to assess the clinical outcome.

Methods: We reviewed the medical records of 275 women who underwent LLETZ for precancerous lesions in cervix. We divided them into two groups according to pregnancy possibility in the future: nonpotential versus potential group. The potential group was arbitrarily defined as women who met one of the following: (i) regardless of marital status, younger than 41 years with less than two parities and (ii) regardless of parity, younger than 46 years and unmarried. After propensity score matching (1:1, 44 women in each group), we compared the extent of LLETZ with respect to short-term recurrence.

Results: After LLETZ, similar percentages of patients were finally diagnosed with ≥CIN3 (cervical intraepithelial neoplasia 3) in the two groups (27 [61.4%] vs 32 [72.7%], P = 0.257). Notably, the largest transverse diameter of LLETZ specimen was significantly larger in the nonpotential group (2.74 ± 1.06 vs 2.37 ± 0.62 cm, P = 0.047). There were more women with exocervical resection margin involvement in the potential group than in the nonpotential group (14 [31.8%] vs 6 [13.6%], P = 0.042). However, there was no significant difference in the incidence of short-term recurrence ≥HSIL (high-grade squamous intraepithelial lesion) within 24 months after LLETZ between the two groups (1 [2.3%] vs 1 [2.3%], P > 0.999).

Conclusion: Pregnancy possibility in the future may affect the extent of LLETZ, as assessed by the largest transverse diameter obtained. This finding may be associated with increased resection margin involvement in women with future pregnancy possibility.

Keywords: cervical intraepithelial neoplasia; large loop excision of the transformation zone; pregnancy; recurrence; resection margin.

MeSH terms

  • Adult
  • Electrosurgery / adverse effects*
  • Female
  • Gynecologic Surgical Procedures / adverse effects*
  • Humans
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Recurrence, Local* / diagnosis
  • Neoplasm Recurrence, Local* / pathology
  • Neoplasm Recurrence, Local* / surgery
  • Pregnancy
  • Pregnancy Complications / etiology*
  • Retrospective Studies
  • Squamous Intraepithelial Lesions of the Cervix* / diagnosis
  • Squamous Intraepithelial Lesions of the Cervix* / pathology
  • Squamous Intraepithelial Lesions of the Cervix* / surgery
  • Trachelectomy / adverse effects
  • Uterine Cervical Dysplasia* / diagnosis
  • Uterine Cervical Dysplasia* / pathology
  • Uterine Cervical Dysplasia* / surgery
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / surgery