LLETZ (Large Loop Excision Transformation Zone) in the management of cervical intraepithelial neoplasia with positive margins: a retrospective comparative analysis

ABSTRACT

Objective. Evaluate the outcomes of LLETZ in patients with cervical intraepithelial neoplasia to determine if conservative post‑conization follow‑up is reasonable.

Materials and Methods. Retrospective observational study where 370 patients who underwent LLETZ between January 2021 and December 2023 at a single tertiary center were analyzed. Inclusion criteria: colposcopic biopsy confirmed diagnosis of cervical intraepithelial neoplasia, no prior cervical interventions. Exclusion criteria: history of vaginal intraepithelial neoplasia, pregnancy and immunocompromised status. Patients were stratified by margin status in positive margins (n = 48) (endocervical and exocervical) versus complete excision (n = 322). Follow‑up included colposcopy, Pap test, and high‑risk HPV testing at 3 months (positive margins only), 6 months, and 12 months. Statistical analyses were performed with SPSS 26 with significance set at p ≤ 0.05.

Results. Among 370 patients, the definitive histology was CIN 1(150 cases), CIN 2(134), CIN 3(82), with a few cases of carcinoma. The 18 patients positive endocervical margins, achieved complete regression at 6 months, the 30 with positive exocervical margins, all had normal colposcopic and PAP findings at 6 months (20% transient positive HPV test). In the complete excision group, follow-up revealed a comparable rate of abnormal findings. Comparative analysis did not reveal a statistically significant difference in recurrence rates between the two groups (p ≤ 0.05), suggesting that conservative management could be reasonable.

No patient in the positive margin group required immediate re‑excision.

Conclusions. LLETZ is a safe, effective treatment for CIN. Positive surgical margins do not necessarily predict a higher risk of residual disease. Longer‑term, prospective studies with HPV genotyping are needed to optimize surveillance guidelines.