Treatment Failure Following Large Loop Excision of the Transformation Zone for the Treatment of Cervical Intraepithelial Neoplasia at Rajavithi Hospital
Sathone Boonlikit MD*, Pojanee Junghuttakarnsatit MD*, Suvanna Asavapiriyanont MD*
Affiliation : * Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok
Objective : To evaluate the treatment failure rate of large loop excision of the transformation zone (LLETZ) in
the treatment of cervical intraepithelial neoplasia (CIN) and the risk of persistence or recurrence depending
on the clinicopathologic factors.
Material and Method: Retrospective case-record review of 250 women who had a final diagnosis of CIN and
underwent LLETZ in Rajavithi Hospital from June 1st, 1998 to December 31st, 2003. Computerized files of these
patients were then reviewed for clinicopathological follow-up results.
Results : Success rate of 86.8% was obtained. The incidence of treatment failure was 13.2%. The clinicopatho-
logic factor associated with the persistence or recurrence was the presence of CIN at the margin of excision.
Of 69 cases with incomplete excision (positive margin), treatment failure developed in 29.0%, compared to
5.2% in patients with complete excision (negative margins) (p < 0.001). Using multivariate analysis, incomplete
excision and endocervical margin involvement of specimen were independent risk factors for the treatment
failure of CIN.
Conclusion : LLETZ is an effective treatment for CIN. Treatment failure rate is low. Positive surgical margin is
a predictor of persistence or recurrence after LLETZ. Incomplete excision and endocervical margin involve-
ment of specimen are significant independent risk factors.
Keywords : LLETZ, Persistent disease, Recurrence, Treatment failure, Positive margin
