Treatment of women with CIN3: LEEP versus hysterectomy—a retrospective study

Background: To compare the therapeutic effectiveness of hysterectomy and loop electrosurgical excision procedure (LEEP) in the treatment of cervical intraepithelial neoplasia grade 3 (CIN3), with a focus on recurrence rates and major complications. Methods: This retrospective study included patients operated between January 2017 and December 2021 with a pathological diagnosis of CIN3. Only patients diagnosed with CIN3 for the first time through cervical biopsies were included. Cases with a diagnosis other than CIN3 after LEEP or hysterectomy were excluded. A total of 100 patients were analyzed, with 50 patients undergoing LEEP (Group 1) and 50 undergoing hysterectomy (Group 2). Results: The median follow-up time was 49.5 months (range: 24–84 months). In Group 1, three patients experienced a recurrence of CIN3 during follow-up and underwent repeat excision procedures. In Group 2, one patient developed vaginal intraepithelial neoplasia grade 3 (VaIN3) after hysterectomy. There was no significant difference in recurrence-free survival between the two groups (p = 0.321). Smoking status was not significantly associated with recurrence (p = 0.527). Conclusions: Although no significant difference in recurrence rates was observed between LEEP and hysterectomy for the treatment of CIN3, the small number of recurrences limits the ability to draw definitive conclusions about the superiority of one treatment over the other. Given the well-documented low risk of cervical cancer after LEEP and its minimally invasive nature, LEEP remains the preferred treatment option for CIN3. Further large-scale studies are needed to evaluate the long-term outcomes of different treatment modalities for CIN3.

Cervical intraepithelial neoplasia; Hysterectomy; Loop electrosurgical excision procedure

[1] Fitzgerald RC, Antoniou AC, Fruk L, Rosenfeld N. The future of early cancer detection. Nature Medicine. 2022; 28: 666–677.

[2] Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: epidemiology, risk factors and screening. Chinese Journal of Cancer Research. 2020; 32: 720–728.

[3] Musalia WA. A review of radical hysterectomy as primary treatment for early stage cervical cancer at KNH 2013–2018. 2021. Available at: http://erepository.uonbi.ac.ke/handle/11295/160556 (Accessed: 04 April 2024).

[4] Önal B, Yılmaz FA. Attitudes of women toward for early diagnosis of cervical cancer: health responsibility and associated factors. Cukurova Medical Journal. 2020; 45: 14–21.

[5] Loopik DL, Bentley HA, Eijgenraam MN, IntHout J, Bekkers RLM, Bentley JR. The natural history of cervical intraepithelial neoplasia Grades 1, 2, and 3: a systematic review and meta-analysis. Journal of Lower Genital Tract Disease. 2021; 25: 221–231.

[6] Ding T, Li L, Duan R, Chen Y, Yang B, Xi M. Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia. International Journal of Gynecology & Obstetrics. 2023; 160: 538–547.

[7] Keskin HL, Erdoğan F, Avşar F. Detection rate of paratubal and Morgagni cyst in hysterectomy cases. Türk Jinekolojik Onkoloji Dergisi. 2024; 24: 66–73.

[8] Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. The New England Journal of Medicine. 2018; 379: 1895–1904.

[9] Tanaka M, Yamanoi K, Taki M, Kitamura S, Sunada M, Chigusa Y, et al. High-grade vaginal intraepithelial neoplasia after hysterectomy for high-grade cervical intraepithelial neoplasia: is hysterectomy a “definitive” treatment compared to conization? Journal of Obstetrics and Gynaecology Research. 2023; 49: 2361–2369.

[10] Malevolti MC, Lugo A, Scala M, Gallus S, Gorini G, Lachi A, et al. Dose-risk relationships between cigarette smoking and cervical cancer: a systematic review and meta-analysis. European Journal of Cancer Prevention. 2023; 32: 171–183.

[11] Nagelhout G, Ebisch RM, Van Der Hel O, Meerkerk G, Magnée T, De Bruijn T, et al. Is smoking an independent risk factor for developing cervical intra-epithelial neoplasia and cervical cancer? A systematic review and meta-analysis. Expert Review of Anticancer Therapy. 2021; 21: 781–794.

[12] Gupte HA, D’Costa M, Gupta S, Sonawane V. Integration of a tobacco cessation program into a rural community-based maternal and child health program in india: a stakeholders’ perspective on task shifting. Nicotine & Tobacco Research. 2024; 26: 1209–1217.

[13] Bogani G, Sopracordevole F, Ciavattini A, Vizza E, Vercellini P, Ghezzi F, et al. HPV persistence after cervical surgical excision of high-grade cervical lesions. Cancer Cytopathology. 2024; 132: 268–269.

[14] Bogani G, Sopracordevole F, Ciavattini A, Ghelardi A, Vizza E, Vercellini P, et al. HPV-related lesions after hysterectomy for high-grade cervical intraepithelial neoplasia and early-stage cervical cancer: a focus on the potential role of vaccination. Tumori Journal. 2024; 110: 139–145.