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Recurrent and Persistent SIL After LETZ in
198 Patients. A San Carlo Hospital Retrospective Study
F.
Corrado, S. Votano*, V.Petrocelli*, Samaritani*,
G. Corrado**, G.M. Galati **, E. Vizza ** and
C. Sbiroli** San
Carlo Hospital – IDI: ** I.R.E. –
I.F.O.- *Gynecology Dep.: ** Gynecol. Oncol. Dep.,
Rome, Italy
Objective
Squamous Intraepithelial Lesions (SIL) represent one
of the major object of preventive medicine. Aim of
the study is to analyse a group of patients with recurrent
and persisent SIL after Loop Excision of the Transformation
Zone (LETZ), in order to detect a marker which can
predict the therapeutic outcome.
Material
and Methods
From December 1994 to February 2001, 198 patients
with hystological and cythological diagnosis of SIL
were treated with LETZ. A mean of 25 sections have
been perfomed on each cervical sample (mean diameter
20 x 15 x 10 mm). A colposcopy control and Pap-test
have been performed after 4 months and every 6 mounths
for the first 2 years. All patients with negative
colposcopy and Pap-test underwent cytology and colposcophy
once a year . Mean follow-up was 36 months (range…)
In this group of patients we evaluated the significance
of positive margins of resection, the colposcopic
grading, the visibility of the transformation zone
(ZT) and the presence of high risk HPV (HPVHR) DNA
test.
Results
Persistent SIL was observed in 8 pts. (4 %); 8 pts
(4 %) presented recurrent SIL. 3/8 patients had a
colposcopic lesion of grade 1(TA1)>1 cm. With ZT
visible, 2/8 had a TA1 with ZT not fully visible,
2/8 a TA2 with ZT endocervical. Negative margins of
resection are not associated with a normal cervix
(residual disease observed 5/8 pz) while the presence
of SIL at the margins seems to be not a marker of
persistency or recurrence at follow-up (49/198 pz).
Few detection of HPVHR (7/16 pz with persistence/recurrent)
in this study, cannot represent a significative prognostic
e/or predictive factor.
Conclusion
Colposcopic findings, cyto-histological grading and
the extension of the lesions represent an important
predictive marker of persistency. Free marginal lesions
are not associated with a normal cervix (residual
disease observed) while the presence of SIL at the
margin lesions seems to be not a marker of persistency
or recurrence at follow-up. Positive HPVHR DNA test
may represent a marker of high risk desease.
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