Prevalence and Risk Factors of LEEP Margin Involvement

Abstract

Objective To determine the prevalence and factors associated with incomplete margins in women with CIN undergoing LEEP.

Design                Cross-sectional study.

Setting                Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol

University.

Subjects A total of 187 women who underwent LEEP between Januaryl, 1998 and December 31,2000.

Methods Medical records of 187 women were reviewed. Data collection included baseline characteristics, Pap smear results, colposcopic findings, and all related cytologic and histologic results.

Results               The prevalence of cervical LEEP margin involvement was 35.3%. Positive ectocervical

and endocervical margins were found in 19.3% and 16.0% respectively. In addition, 10.7% showed positive on both ectocervical and endocervical margins. Independent risk factors for any margin involvement were age > 40 years (OR 3.0 and 2.9 respectively), endocervical extension of lesions (OR 2.8 and 3.5 respectively), and invasive results from Pap smear (OR 3.9 and 6.9 respectively). On the other hand, invasive results from Pap smear was the only independent risk for ectocervical margin involvement (OR 4.6).

Conclusion Cervical LEEP margin involvement was found in approximately one-third of women underwent LEEP (35.3%). Important risk factors associated with incomplete excision were older age, endocervical extension of lesions, and invasive cancer on Pap smear. Such factors should be considered in all women indicated for LEEP and appropriate technique should be used to reduce the risk of margin involvement.