%0 Journal Article
%T Implications of Post-LLETZ ˇ°Treatment Failureˇ± for Further Management of HIV-Infected Women
%A Louis-Jacques van Bogaert
%J Journal of Cancer Research
%D 2014
%R 10.1155/2014/486460
%X Background. Since the preconisation presence of high-risk human papillomavirus (HR-HPV) is the main determinant of the risk of progression of preinvasive lesions; the state of the excision margins could be of less importance. Relatively little is known about the effect of human immunodeficiency virus (HIV) infection on the relation between the states of the excision margins. Methods. We compared 120 HIV-infected and 139 HIV-uninfected women who underwent a hysterectomy after large loop excision of the transformation zone (LLETZ) for abnormal Pap smear. Results. The excision margins had been reported negative in 21.7% of infected and 7.8% of uninfected cases ( ). Three (11.5%) of 26 negative margins in HIV-infected and 2 (18.2) out of HIV-uninfected cases were falsely negative as evidenced on hysterectomy specimens ( ). The persistence rate of the initial lesion was similar in both groups ( ). The persistence rate with highly active antiretroviral treatment (HAART) was similar to untreated patients ( ). The progression rate from low-grade to high-grade preinvasive lesions was higher in HIV-infected than HIV-uninfected women ( ). Conclusion. HIV-infected women with incomplete excision margins after LLETZ are at higher risk of progression of residual preneoplastic lesions. 1. Introduction The prevention of cervical cancer is twin-pronged: primary (i.e., vaccination and life style) and secondary (i.e., screening and treatment). Many screening strategies are still under investigation and awaiting validation. They comprise cytology and/or human papillomavirus (HPV) testing, visualization of the cervix (naked eye, colposcopy, and cervicography), and excision or destruction of preinvasive lesions [1]. Destruction (by cryotherapy or laser) has the disadvantage of lacking ˇ°gold standardˇ± biopsy confirmation but the advantage of on the spot treatment (see and treat) [2]. This is of special importance in low-resource settings (LRS). Excision methods are many: cold knife conisation (CKC) and thermal excision called either large loop excision of the transformation zone (LLETZ) or loop electrosurgical excision procedure (LEEP). Both allow for histopathological diagnosis although, as opposed to CKC, they have the possible disadvantage of burn artifacts of the excision margins. The state of the excision margins (healthy or involved by the preneoplastic process) is, arguably, a prognostic indicator and a guide to further follow-up [3]. LRS like sub-Saharan Africa carry the double burden of inexistent or inefficient screening programs and high cervical cancer and human
%U http://www.hindawi.com/journals/jcr/2014/486460/