Loop Electrosurgical Excision Procedure in Managing Persistent Low-Grade Abnormality or Human Papillomavirus Positivity. Issue 4 (20th October 2021)

• Record Type: Journal Article
• Authors: Leung, Shuk On Annie; Vitonis, Allison F.; Feldman, Sarah
• Is Part Of: Journal of lower genital tract disease. Volume 25:Issue 4(2021)
• Page Start: 281
• Page End: 286
• Publication Date: 2021-10-20
• Subjects: loop electrosurgical excision procedure -- high-grade dysplasia -- human papillomavirus; Generative organs, Female -- Diseases -- Periodicals; Cervix uteri -- Diseases -- Periodicals; Generative organs -- Diseases -- Periodicals; Sexually transmitted diseases -- Periodicals; 618.1
• DOI: 10.1097/LGT.0000000000000619
• Languages: English
• ISSNs: 1089-2591

Abstract

Abstract : Objectives: The aims of the study were to estimate the rate and to identify predictors of high-grade abnormalities among women with persistent low-grade abnormalities or high-risk human papillomavirus (hrHPV) positivity for at least 2 years stratified by presence (high risk) or absence (low risk) of previous high-grade results or HPV 16/18. Materials and Methods: A retrospective cohort study of patients who underwent a loop electrosurgical excision procedure (LEEP) for persistent low-grade or hrHPV positivity was performed. Patients were stratified based on whether they had a history of high-grade and/or HPV 16/18 positivity. Rates of high-grade or worse abnormalities on LEEP were compared using Fisher exact tests. Logistic regression was used to evaluate the associations between patient characteristics and high-grade results on the LEEP. Results: Three hundred eleven LEEPs were performed for persistent low-grade or hrHPV positivity. The rates of occult high grade were 12% and 22% among the low- and high-risk groups, respectively. Compared with those 45 years and older, the adjusted odds of high grade was 3.79 (95% CI = 1.19–12.1) for women aged 25–29 years. The odds of high grade was higher among current versus never smokers (6.40; 95% CI = 2.01–20.4) and those with a history of high-grade abnormality (2.23; 95% CI = 1.12–4.43). At 2 years, approximately half had an abnormal cytology and/or hrHPV positivity result independent of whether high grade was identified on their LEEP specimen. Conclusions: Patients with persistent low-grade abnormalities or persistent hrHPV should be counseled on the risks and benefits of a LEEP given that 12%–22% have a risk of occult high grade, especially if they have a history of high-grade dysplasia.