Work

Predictive factors for the absence of high‐grade intraepithelial lesions in LLETZ specimens following a prior histological diagnosis

Year: 2026

Type: article

Abstract: INTRODUCTION: To identify predictive factors of the absence of high-grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high-grade intraepithelial lesion. MATERIAL AND METHODS: We conducted a multicenter retrospective study in nine hospitals. All patients treated by large loop excision of the transformation zone following histological diagnosis of high-grade intraepithelial lesion between 2015 and 2021 were included. All patients had initial diagnosis of high-grade intraepithelial lesion performed on cervical biopsy and/or endocervical curettage. Clinical, cytological, colposcopic, and high-grade intraepithelial lesion data were extracted from medical files. The primary endpoint was the absence of high-grade intraepithelial lesion on the specimen, defined either by the identification of a low-grade intraepithelial lesion only or by the absence of any intraepithelial lesion. RESULTS: A total of 2037 patients were included. The absence of high-grade intraepithelial lesion was identified in 191 (9.4%) patients. Three predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen were identified: a small abnormal transformation zone defined by cervical involvement less than or equal to one quadrant (aOR: 2.01; 95%CI: 1.47-2.75; p < 0.001), a colposcopic impression of normal cervix or minor changes (aOR: 1.73; 95%CI: 1.24-2.42; p = 0.001), and normal or low-grade or ASC-US cytology (aOR: 1.37; 95%CI: 1.00-1.87; p = 0.049). CONCLUSIONS: Predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen of patients with a histological diagnosis of high-grade intraepithelial lesion are a small abnormal transformation zone, a colposcopic impression of normal cervix or minor changes, and normal, low-grade or ASC-US cytology. Practitioners should take these three elements into account when considering large loop excision of the transformation zone treatment in women with a proven diagnosis of high-grade intraepithelial lesion.

Source: Acta Obstetricia Et Gynecologica Scandinavica

DOI: 10.1111/aogs.70213