Management of loop electrosurgical excision procedure with positive margins.

Abstract

5534 Background: Loop Electrosurgical Excision Procedure (LEEP) is a primary management for preinvasive cervical disease. While often successful, around 10% will have disease extend to the margin of the LEEP specimen, leaving the possibility of pathology extended beyond the excised region. The American Society for Colposcopy and Cervical Pathology (ASCCP) provides management options for LEEP with positive margins, which include hysterectomy, repeat LEEP, or follow-up in 6 months with either: HPV-based testing or colposcopy with endocervical curettage. Limited data exists in the comparison of management options. Methods: This retrospective study included patients with cervical preinvasive disease referred to a single academic institution between 1/2022 to 12/2024 who underwent LEEP found to have a positive margin. Demographics and pathology results were obtained from medical records. The primary outcome was follow-up colposcopy pathology in patients who had a positive margin from LEEP. Statistical analysis was performed using GraphPad. Results: 67 patients underwent follow-up colposcopy after a LEEP with a positive margin. At time of LEEP, the median age was 34.5 years with 36% Hispanic, 34% African American, 22% White, and 2% Asian. With HPV status prior to LEEP, 72% were non-genotyped high risk (HR), 6% HPV16+, 6% HPV18+, and 3% were other HR+. Positive margins were either CIN 2 (N=12) or CIN 3 (N=55) and either endocervical (N=40), peripheral (N=15), both endocervical and peripheral (N=7), or unspecified (N=5). Pathology at follow-up colposcopy was primarily negative/low-grade disease (83.6%) with a minority being high-grade disease (16.4%). CIN 2 or CIN3 at the margin was not associated with high-grade disease on follow-up colposcopy (0% vs. 26.7%; p=0.108). The median age at time of LEEP did not significantly differ between CIN 2 or CIN3 positive margins (37.5 vs 34.9y; p=0.274) and was not associated with negative/low-grade or high-grade disease at follow-up colposcopy (38.4 vs 35.7y, p=0.251). Race was not associated with high-grade disease on follow-up colposcopy (p=0.239). There was no difference between high-grade lesion on colposcopy and location LEEP positive margin (p=0.998). HPV 16+ or 18+ was not associated with high-grade pathology at follow up colposcopy (p=0.289). Conclusions: In our diverse population, the prevalence of high-grade disease on follow-up colposcopy is low regardless of having CIN 2 or CIN 3 at any margin at time of LEEP. Numerically, CIN 2 margins were less likely to have positive high-grade colposcopy when compared to CIN 3 margin. Race nor age were associated with high-grade disease on follow-up colposcopy. While ASCCP offers follow-up repeat colposcopy in the setting of positive margins, prospective studies could be beneficial in determining if less-invasive options, such as HPV testing are sufficient for follow-up in this population.