Predictive factors for the absence of high‐grade intraepithelial lesions in LLETZ specimens following a prior histological diagnosis

Abstract Introduction To identify predictive factors of the absence of high‐grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high‐grade intraepithelial lesion. Material and Methods We conducted a multicenter retrospective study in nine hospitals. All patients treated by large loop excision of the transformation zone following histological diagnosis of high‐grade intraepithelial lesion between 2015 and 2021 were included. All patients had initial diagnosis of high‐grade intraepithelial lesion performed on cervical biopsy and/or endocervical curettage. Clinical, cytological, colposcopic, and high‐grade intraepithelial lesion data were extracted from medical files. The primary endpoint was the absence of high‐grade intraepithelial lesion on the specimen, defined either by the identification of a low‐grade intraepithelial lesion only or by the absence of any intraepithelial lesion. Results A total of 2037 patients were included. The absence of high‐grade intraepithelial lesion was identified in 191 (9.4%) patients. Three predictive factors of high‐grade intraepithelial lesion absence on large loop excision of the transformation zone specimen were identified: a small abnormal transformation zone defined by cervical involvement less than or equal to one quadrant (aOR: 2.01; 95%CI: 1.47–2.75; p < 0.001), a colposcopic impression of normal cervix or minor changes (aOR: 1.73; 95%CI: 1.24–2.42; p = 0.001), and normal or low‐grade or ASC‐US cytology (aOR: 1.37; 95%CI: 1.00–1.87; p = 0.049). Conclusions Predictive factors of high‐grade intraepithelial lesion absence on large loop excision of the transformation zone specimen of patients with a histological diagnosis of high‐grade intraepithelial lesion are a small abnormal transformation zone, a colposcopic impression of normal cervix or minor changes, and normal, low‐grade or ASC‐US cytology. Practitioners should take these three elements into account when considering large loop excision of the transformation zone treatment in women with a proven diagnosis of high‐grade intraepithelial lesion.