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Among women treated for high-grade precancerous changes to the cervix, the probability of recurrence or persistence is linked with patient age, the extent of the cervical abnormalities, and the completeness of the surgical removal. These results were published in the journal Obstetrics and Gynecology.

The cervix is a female reproductive organ that forms the lower portion of the uterus. Cervical cancer occurs when cervical cells grow out of control. When cells grow out of control, they spread and grow throughout the cervix and may invade and destroy neighboring organs or break away and spread to other parts of the body through the bloodstream and lymphatic system.

Effective screening programs for cervical cancer have decreased the frequency of this disease. Screening can detect precancerous changes to the cervix, known as cervical intraepithelial neoplasia (CIN). The severity of CIN is classified on a scale of 1 to 3, with 3 being the most severe. Because the more severe types of CIN may progress to cervical cancer, removal of these lesions reduces the risk of cancer.

CIN is often treated with surgical procedures that remove abnormal parts of the cervix but leave the rest of the uterus intact. These procedures include loop electrosurgical excision procedure (LEEP), cold-knife conization, or laser conization. Conization refers to the surgical removal of a cone-shaped piece of tissue from the cervix. CIN may also be treated by cryosurgery (freezing of abnormal cells on the surface of the cervix) or laser ablation (use of a laser to destroy abnormal cells on the surface of the cervix).

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CIN, particularly CIN 3, can persist or recur following treatment. To identify predictors of CIN persistence or recurrence among women treated for CIN 3, researchers in Taiwan conducted a study among 449 women. All the women underwent conization for treatment of CIN 3. After conization, a curette (a spoon-shaped instrument) was used to remove additional tissue from cervix. The average patient age was 46 years.

Sixty-four women experienced persistent or recurrent CIN. Women were more likely to experience persistent or recurrent CIN if they were over the age of 50, had CIN 3 at the edge of the tissue removed by conization (positive surgical margin), had CIN 3 in the tissue removed by curette, or had CIN 3 in multiple areas of the cervix.

The researchers conclude that several factors influence the probability of persistent or recurrent CIN after conization, and that these factors should be considered before and after treatment of patients with CIN 3.

Reference: Lu C-H, Liu F-S, Kuo C-J et al. Prediction of Persistence or Recurrence After Conization for Cervical Intraepithelial Neoplasia III. Obstetrics and Gynecology. 2006;107:830-5.