1. Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ)
- Author
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Eijsink, J.J.H., de Bock, G.H., Kuiper, J.L., Reesink-Peters, N., van Hemel, B.M., Hollema, H., Nijman, H.W., Mourits, M.J.E., and van der Zee, A.G.J.
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SQUAMOUS cell carcinoma , *PAP test , *SURGICAL excision , *COHORT analysis , *PATIENT compliance , *CELLULAR pathology - Abstract
Abstract: Objective: To assess the compliance of HSIL patients to the national Dutch routine follow-up protocol in the first 2 years after LLETZ and to determine if based on the status of excision margins, follow-up intervals could be modified. Methods: A prospective cohort study was performed in patients, referred because of an abnormal Pap smear between 1996 and 2004 and treated for HSIL with LLETZ. The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 months, respectively. Follow-up results were completed by using PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands. To assess compliance to the follow-up protocol, adequate follow-up was defined as three cervical smears taken after 6 (+/−3), 12 (+/−3) and 24 (+/−3) months, respectively. Results: Compliance to the first 2 years follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second and third follow-up cervical smears, respectively. Patients with involved excision margins had a three times higher overall risk of developing a subsequent HSIL after LLETZ as compared to patients with free excision margins (HR: 3.2, 95% CI=1.3–7.9, p =0.01). Risk for diagnosing HSIL during the first 12 months of follow-up for patients with free excision margins was only 1%. Conclusions: Compliance to the Dutch national routine follow-up protocol in HSIL patients after LLETZ is only moderate. For HSIL patients with free excision margins after LLETZ the first cytological follow-up interval can safely be increased to 12 months. [Copyright &y& Elsevier]
- Published
- 2009
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