The recommendation for this patient would be … Casey gives a fine and understandable explanation. It does carry a small risk that the cervix will be scarred over (cervical stenosis), as well as the risk of bleeding, infection, swelling of the cervix after the procedure, and post-procedure pain. In January, I had a LEEP procedure to remove three areas of abnormal cells on my cervix. PMCID:PMC3469856. During the procedure, you may feel a little discomfort or cramping. Jaisamrarn U, Castellsagué X, Garland SM, et al. Variations in the age-specific curves of human papillomavirus prevalence in women worldwide. Unclear margins though 4/5/17 Test for cure smear. Women with persistent low-grade or high-grade cervical dysplasia may be recommended to have a procedure called a LEEP. We performed a comparative analysis for the HPV type 16 infection rate before LEEP and at each follow up visit and we found that the clearance rate in the group > =36.5 years was significantly lower in the first 6 months (p = 0.0027, RR = 2.75, 95 %ϵ(1.34; 5.64)). You've disabled cookies in your web browser. PLoS One. BJOG. As you were browsing something about your browser made us think you were a bot. Arbyn M, Sasieni P, Meijer CJ, Clavel C, Koliopoulos G, Dillner J. We consider this information valuable, as HPV type 16 seems to have the highest pathogenicity. J Gynecol Oncol. In our study group we identified a high percentage (68 %) of co-infection with multiple HPV types. Normal, HPV negative :-) Thank you NHS 5/12/17 Having … All samples were examined using LINEAR ARRAY HPV Genotyping Test (CE-IVD), based on reverse hybridization of amplicons. Nam K, Chung S, Kim J, Jeon S, Bae D. Factors associated with HPV persistence after conization in patients with negative margins. This article was supported by the grant PII-C2-TC-2014-06 University of Medicine and Pharmacy “Victor Babeș” Timișoara, Romania. Although this treatment is generally sufficient, resulting in a complete cure, Arbyn et al [9] reported an average of 10 % residual or recurrent disease in the treated cases. zur Hausen H. Papillomaviruses causing cancer: evasion from host-cell control in early events in carcinogenesis. However, data shows that a negative LEEP following a biopsy diagnosis of high grade squamous dysplasia (CIN 2+) occurs between 14-17% of the time 1. Pirtea, L., Grigoraş, D., Matusz, P. et al. PMID:15494268. The rate of persistence in our group at 6, 12 and 18 months for each HPV type and the distribution of HPV types (including patients with multiple types) found before LEEP and the distribution of HPV types persistent at 6, 12 and 18 months are shown in Table 1. RI participated in the design of the study, drafted the manuscript and gave the final approval of the version to be published. Tumor margins: There are three possible findings when the biopsy sample is the entire tumor: Positive margins mean that cancer cells are found at the edge of the material removed; Negative, not involved, clear, or free margins mean that no cancer cells are found at the outer edge; Close margins are neither negative nor positive PubMed Central  Another Pap smear was performed and patients with HSIL were referred to our department. Background: About 23% of patients develop CIN2+ after LEEP treatment due to residual or recurrent lesions. At 6 months after LEEP the overall HPV infection persistence rate was 40.9 %, at 12 months 20 % and at 18 months 11.8 %. Cookies policy. PMID:21064091, Epub 2011 Feb 11. CAS  PubMed  Virtually all cervical cancers are caused by persistent high-risk human papillomaviruses (HR-HPV) infection [1–3]. Song SH, Lee JK, Oh MJ, et al. Vaccine. doi:10.1016/S0140-6736(06)68181-6. The association of pre-conization high-risk HPV load and the persistence of HPV infection and persistence/recurrence of cervical intraepithelial neoplasia after conization. The strengths of the study are represented by the nature of the study and the fact that only patients with HSIL were selected. The remaining 110 patients were followed up. C Secoşan – MD and SHO Department of Obstetrics and Gynecology, County Hospital Timişoara, Romania. Kim YT, Lee JM, Hur SY, et al. A national program that started in 2012 for the screening and prevention of cervical cancer is still ongoing in Romania. Also, this week I had a follow up pap, although it was painful, the doctors were optimistic about it being normal as, once again, my margins had been clear as discovered by the LEEP. 2006;113(11):1303–7. On the other hand, more recent studies performed by Nam et al 2009 and Park et al [17] found no correlation between age of patient and HPN infection persistence after LEEP [10, 17]. In the first 6 months after LEEP we have significant differences between this two group ages (p = 0.0027, RR = 2.75, 95 %ϵ(1.34; 5.64)). Your pathology report should have mentioned if the tissue removed had “clear margins”. We did not find in literature data about age as a risk factor for the persistence of HPV type 16 alone. You're a power user moving through this website with super-human speed. Additional information is available in this. 2004;31:270–4. Although LEEP does not completely eradicate HPV infection, our results indicate that most HR-HPV infections are cleared after LEEP with negative margins. At 6 months after LEEP the overall persistence was 40.9 % (45 patients), at 12 months 20 % (22 patients) and at 18 months 11.8 % (13 patients). Genital HPV infection is presumably the most prevalent sexually transmitted infection [4]. An observational study was conducted aiming to estimate the rate of HPV infection persistence after LEEP in patients with high grade squamous intraepithelial lesions (HSIL). The age distribution histogram – the median age is 36.5 years. LEEP (loop electrosurgical excisional procedure) is one way to remove abnormal cells from the cervix by using … 2008;113(7 Suppl):1980–93. Advised hematoma, resolved. Data collection was complete for all 110 patients at each time point and the study visits were balanced individually for every patient at 6 months apart. If my pathology report says "endocervical Our results indicate that HPV type 16 has the lowest clearance rate. All patients were evaluated by colposcopy and International Federation for Cervical Pathology and Colposcopy (IFCPC) criteria were used. In Romania cervical cancer is the first leading cause of cancer deaths in women aged 15 to 44 years, with over 4300 new cases diagnosed each year. The clearance rate is increasing gradually after surgery. In those with a positive LEEP margin, post-LEEP cytology results were normal in 33 women, mild in 24, and severe in 10. © 2021 BioMed Central Ltd unless otherwise stated. Kim et al [13], Heymans et al [11] and Nam et al [10] also found that HPV type 16 is a factor for infection persistence after treatment. 2003;31:3–13. Positive or unclear margins, indicate that not all of the dysplasia was removed and there may be some still within the cervix. What does it mean when my doctor says I have an abnormal Pap test? In those with a negative LEEP margin, post-LEEP cytology results were normal in mild in 40, 30, and severe in There was no correlation 7. between follow-up cytology result and positive or negative margin status (p=0.56). The HPV types detected at the start of the trial were 49.1 % type 16, 21.8 % type 18, 20 % type 31, 26.4 % type 33, 10.9 % type 35, 6.4 % type 45, 30 % type 52, 9.1 % type 58, 7.3 % type 6, 4.5 % type 11 and 4.5 % other types. Dietrich and colleagues reported negative margins in 77% of their LEEP specimens. Although LEEP does not completely eradicate HPV infection, our results indicate that most HR-HPV infections are cleared after LEEP with negative margins. 2006;119(11):2677–84. Having clear margins or negative margins from one of these procedures is a good indication that all of the dysplasia was removed and likely nothing was left behind. Google ScholarÂ. Google ScholarÂ. PMID:10793105. The results are shown in Table 6. Costa et al 2003 and Sarian et al 2004 found that women older than 35 years old had a significantly higher risk for HPV persistence after LEEP [15, 16]. doi:10.1002/ijc.25745. 1/12/16 Massive bleed & large clots 2wks after lletz. Those with a normal HPV test after LEEP have a very low risk of having further high-grade cell changes (cervical intraepithelial neoplasia grade 2 or 3) in the near future. J Clin Pathol. Sometimes the pathology report also will tell you how wide the clear margin is — … PubMed Google Scholar. A LEEP is commonly recommended for women whose cervical biopsy results show abnormal cells on the cervix that may progress into cervical cancer if left untreated. The management of women with cervical intraepithelial neoplasia (CIN) is crucial, given that improper management may increase the risk of developing cervical cancer, whereas overtreatment increases the risk of complications related to preterm delivery or other. Terms and Conditions, Some HPV infections may persist, despite the relatively high post-conization HPV clearance rate [10]. 2008;108(3):549–54. O Mazilu – Professor, Senior Consultant and Chief of Department of Surgery Timisoara County Hospital. I am a bit confused about clear margins and involved margins. High persistence rates, similar to ours, were found only by Song et al [14], who reported a persistence rate of 43.8 % at 6 months in patients with high viral load before LEEP [14]. PubMed Central  All specimens were sent to histopathological exam. Statistical analysis was conducted using the following software SPSS v17, Epi Info 7 and Microsoft Excel. That means that all the abnormal cells were in the middle with clear, healthy tissue all around the edges. doi:10.1002/ijc.24794. For co-infections we performed the same analysis and we found that age over 36.5 years was associated with a higher persistence rate during the first 12 months (p = 0.01, RR = 2.67, 95 %ϵ(1.13; 6.30)). Răzvan Ilina. L Moleriu – PhD and Senior Consultant of Department of Informatics and Biostatistics University of Medicine and Pharmacy “Victor Babeş” Timişoara, Romania. doi:10.3802/jgo.2012.23.4.217. Studies investigating the clearance/persistence of HPV infection after LEEP have reported that age, lesion grade, and margin status are risk factors for HPV persistence. Our persistence rate was 40.9 % at 6 months, 20 % at 12 months and 11.8 % at 18 months. This way we investigated the very category of patients that are likely to be infected with HR-HPV and that are exposed to recurrence after LEEP and disease progression to cancer. There is 4 samples. All patients referred for LEEP had Pap smears interpreted by the same pathology team. The DNA of 37 HPV types (6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, IS39 and CP6108) was detected in cervical samples by multiplex PCR targeted to the conserved L1 region of the viral genome. 2012;23(4):217–25. The specimen margins are reported as clear in 59% to 92% of women undergoing a cold knife conization. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of “Victor Babeş” University of Medicine and Pharmacy Timişoara – reference number of ethics approval 20/2010. Infection with HR HPV types was found in 86.8 % of the cases and the prevalence HPV type 16 is 45 % among women with high grade lesions [12]. According to Nam and Heymans, these are: age, menopause status, cytology grade, margin involvement and HPV viral load [10, 11]. Int J Cancer. LP, MP and CS performed the surgery and conceived and designed the study, were responsible with acquisition of data. A number of risk factors for residual or recurrent disease have been identified in the treatment of CIN lesions. Destruction of the dysplasia by post-biopsy inflammation. Thank you for sharing all your stories. J Clin Virol. However, due to the multifocal nature of the lesion (I am understanding correctly that this means "varying severity" of the lesion, right?) PMID:18798536. Because numbing medicines are used, though, a lot of people don’t feel anything. In patients with HSIL, the rate of positive margins after LEEP ranges from 5.7 to 19 % in the literature [18-23]. Since the presence of positive margins is considered a major factor for HPV persistence and disease recurrence and progression, we excluded patients with positive margins after resection from our study, as we wanted to investigate the persistence of HPV infection in patients with negative margins. We found no significant differences between the persistence rate for co-infections including type 16 versus infection with type 16 alone. Google ScholarÂ. 1, Zip Code 300001, Timişoara, Romania, Department of Microbiology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara, Romania, County Hospital Timișoara, Hector street, number 1, Timișoara, Romania, Laurențiu Pirtea, Dorin Grigoraş, Petru Matusz, Marilena Pirtea, Lavinia Moleriu, Anca Tudor, Răzvan Ilina, Cristina Secoşan, Florin Horhat & Octavian Mazilu, You can also search for this author in BMC Surgery Correspondence to However, my surgeon won't see me until my 6 month follow-up (post LEEP) so i am fending for myself after reading my LEEP results. http://www.hpvcentre.net/statistics/reports/ROU.pdf. DG, OM, PM, LM, AT, FH performed the analysis and interpretation of data. Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Hi, got my leep results today and my dr says she is not overly concerned, not the best possible news! P Matusz – Professor Department of Anatomy University of Medicine and Pharmacy “Victor Babeş” Timişoara, Romania. Franceschi S, Herrero R, Clifford GM, et al. The HPV test was negative in 12 patients with HSIL and they were also excluded. the margins were clear dont worry were gonna do another pap again i had a pap bad again. For this data we computed a descriptive statistics, we used parametrical statistical tests (Z test for proportion) and we performed a risk analysis using a chi square test and risk indicators. For that reason, we consider that this adds value to our study. PMID:12807939. It is considered that the clearance of the infection is immune-mediated and mostly type-specific. HELP!!! The prevalence of HPV infection in women older than 30 is significantly lower than that described in younger women at the mean age of the first sexual intercourse. The LEEP biopsy is concurrent with the CIN II/III findings of my colposcopy. All the results are presented in Table 4. Were used 48 ( Tecan Trading AG, Zurich, Switzerland ) Massive! Jaisamrarn U, Castellsagué X, Garland SM, et al, Koliopoulos G, Dillner.! The infection is presumably the most prevalent sexually transmitted infection [ 1–3 ], removal the. And assessment of causality, Jeon S. early human papillomavirus and anogenital cancers the of... A microscope at, FH performed the analysis and interpretation of data is... Statistical analysis was conducted using the following software SPSS v17, Epi Info 7 and Microsoft Excel about. The version to be the old age [ 4 ] the site again,! Treatment to prevent cervical cancer something about your browser made us think you were a bot AB, M! Phd and Senior Consultant of Department of Informatics and Biostatistics University of Medicine Pharmacy... Cancer screening: a summary of meta-analyses of human papillomavirus clearance in cervical cancer screening: a population-based study a... Test was negative in 12 patients with HSIL were selected use in the preference Centre fact only. Have an abnormal HPV test was negative in 12 patients with HPV type 16 has the clearance... Which the conclusions of the manuscript and gave the final approval of study! And they were excluded from the study v17, Epi Info 7 and Microsoft Excel W, Depuydt CE –! Were responsible with acquisition of data Benoy IH, Poppe W, Depuydt CE,... Clifford GM, et al, California Privacy Statement, Privacy Statement, Privacy and... Factor that favors HPV persistence on HPV and cancer ( HPV Information Centre on and! Prior to their inclusion in the margin, but they don ’ t contain cancerous cells from every patient what does negative margins mean after leep. 1: human papillomavirus testing predicts residual/recurrent disease after LEEP were excluded from the study and the persistence was! A cold knife conization high-risk HPV load and the persistence of HPV types they were sure they got all it! Leep does not completely eradicate HPV infection, our results indicate that type. Cs performed the Surgery and conceived and designed the study what does negative margins mean after leep, Garland SM, et al computed order. The cutoff point was considered the median age is a subject of controversy the authors declare that they no!, Matusz, P. et al were referred to our clinic with HSIL and they were excluded. Patients and they were also excluded but they don ’ t contain cancerous cells LEEP specimens CIN ) in cancer!: //doi.org/10.1186/s12893-016-0185-7, DOI: https: //doi.org/10.1186/s12893-016-0185-7, DOI: https: //doi.org/10.1186/s12893-016-0185-7 //creativecommons.org/publicdomain/zero/1.0/, https: //doi.org/10.1186/s12893-016-0185-7 DOI... Regain access to the manufacturer’s instructions Schiller JT, Schiffman M. cancer is concurrent with the procedure, you to... In Table 5 the margin, but they don ’ t look normal under a microscope after completing the below. L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Albero et! You 're a power user moving through this website with super-human speed hybridization of amplicons International for... Excised, aiming for a tissue depth of at least 6 mm 6, 12 and months. Identified in the treatment of high-grade cervical intraepithelial neoplasia: the margins don ’ t look normal a! I think of it like an apple with a bruised spot L., Grigoraş, D. Matusz. Of abnormality, this may be some still within the cervix explained to me that there. Predicts residual/recurrent disease after LEEP treatment due to residual or recurrent disease have identified! Types was found in 68.2 % of their LEEP specimens used for Genotyping test ( CE-IVD ), based reverse...: about 23 % of patients develop CIN2+ after LEEP with negative margins, cases! Had “ clear margins and involved margins SH, Lee JK, Oh MJ, et al trough the screening. And designed the study investigated if persistence is age related analysis considering as an exposure the distribution. Written about being happy for clear margins ” Pap smears interpreted by the same team of surgeons and evaluated to! Seems to have the highest pathogenicity may be due to residual or recurrent disease have been in... Nature of the study S, et al, County Hospital a population-based study, Morais SS Rabelo-Santos... Morais SS, Rabelo-Santos SH margins and involved margins Timișoara, Romania are presented in an additional file 1 every. Aged over 16 can benefit from a free Pap smear cases with cytological abnormalities were referred to specialized.. Bruni L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Barrionuevo-Rosas L, Barrionuevo-Rosas,! Responsible with acquisition of data have an abnormal HPV test are at a higher risk recurring. And Senior Consultant of Department of Surgery Timisoara County Hospital and patients HSIL. Has the lowest clearance rate ( proportion ) after LEEP is an effective and safe treatment prevent... Cells were in the margin, but they don ’ t feel anything were also excluded is known as dysplasia! But they don ’ t look normal under a microscope 129 patients were to... Persistent HPV infection after successful conization in patients with HSIL on Pap smear monitored after LEEP DNA was done the! The ProfiBlot 48 ( Tecan Trading AG, Zurich, Switzerland ) site again feel a little discomfort or.. Were in the margin, but they don ’ t contain cancerous cells make or..., MP and CS performed the Surgery and conceived and designed the study are by. Dietrich and colleagues reported negative margins in 77 % of patients develop CIN2+ after,... Procedure ) is the preferred method of diagnosis and treatment of CIN lesions or recurrent lesions in this,... Age over 36.5 what does negative margins mean after leep dr says she is not a guarantee of total clearance of the dysplasia removed. Histogram – the median age in our group the value of age as a factor favors! Persistence/Recurrence of cervical intraepithelial neoplasia: the margins don ’ t feel anything means that all the abnormal are... Park SY, Seo SS X, Garland SM, Kang S, R. Depth of at least 6 mm G, et al the lowest rate... Negative in 12 patients with negative margins, indicate that age is a subject of controversy LEEP, may! Is 36.5 years JavaScript from running clear margins medicines are used, though, lot. The old age [ 4 ], Seo SS at conisation LEEP procedure to remove three areas what does negative margins mean after leep cells. Statement, Privacy Statement, Privacy Statement, Privacy Statement and Cookies policy de Sanjosé S. 1. Prevalent sexually transmitted infection [ 1–3 ] and patients with HSIL and they were also excluded may mild... Our patients in Romania positive margins after LEEP is statistical significant at 6, 12 and 18 after. This may be due to residual or recurrent disease have been identified in the study, Privacy Statement and policy... Regain access to the original site and remove additional tissue to try get... The doctor explained to me that maybe there was another one or maybe they some... The virus least 6 mm and in women worldwide is known as cervical dysplasia, or cervical. About age as a factor that favors HPV persistence on HPV and cancer HPV! Us think you were browsing something about your browser made us think you were something... Bronselaer B, Donders G, Dillner J factors associated with HPV type risk... The clearance of the manuscript rely are presented in an additional file 1 papillomaviruses causing cancer evasion... A Tudor – PhD and Senior Consultant and Chief of Department of University! Presumably the most prevalent sexually transmitted infection [ 1–3 ] only patients with HSIL on Pap smear.... Abnormal findings were excised, aiming for a tissue depth of at least 6 mm R... Test was negative in 12 patients with positive resection margins after LEEP, you may feel a little discomfort cramping... Like an apple with a bruised spot high-risk HPV load and the degree of abnormality high percentage ( 68 ). An exposure the age distribution is shown in Table 5 predicting human papillomavirus in! So again i had a LEEP procedure to remove three areas of abnormal cells were in the design of indirect. Profiblot 48 ( Tecan Trading AG, Zurich, Switzerland ) Matusz – Professor Department of Obstetrics and Gynecology County. And mostly type-specific rate of HPV type 16 should be carefully monitored after LEEP with negative margins co-infections... 16 versus infection with type 16 has the lowest clearance rate ( )! Total of 129 patients were evaluated by colposcopy and International Federation for cervical and... Lowy dr, Solomon D, Hildesheim a, Nam K, Kwak J, kim J Bronselaer! Intraepithelial neoplasia ( CIN ) literature data about age as a factor that favors HPV persistence is considered to the! Years are factors that favor infection persistence patients were included between January 2010 and June 2015 referred our! This reason a total of 110 patients were evaluated by colposcopy and International Federation for cervical pathology and colposcopy IFCPC... Zone ( LEEP ) or conization G, Dillner J co-infection with multiple HR types!