Loop electrosurgical excision procedure (LEEP) plus top hat for HIV‐infected women with endocervical intraepithelial neoplasia in Kenya
Obstetrics and Gynaecology (East Africa); Pathology (East Africa); Population Health (East Africa)
Objective: To determine the utility of detecting endocervical cervical intraepithelial neoplasia (CIN) 2+ with endocervical curettage (ECC) and treating with loop electrosurgical excision procedure (LEEP) plus top hat (+TH) among women with HIV.
Methods: Cytology was followed by coloscopy‐directed biopsy if participants had HSIL or ASC‐H and biopsy plus ECC if there were glandular cells present. CIN2/3 on ECC and/or inadequate colposcopy (ENL) was treated with LEEP+TH, while CIN2/3 on ectocervix (ECL) received LEEP alone. Recurrent CIN2+ were compared over a 2‐year follow‐up.
Results: Of 5330 participants, 160 underwent ECC, 98 were CIN2/3 on ECC, and 77 received LEEP+TH. ECC detected 15 (9%) more women with CIN2/3 than biopsy alone. Women were more likely to have ENL if they were older (≥45 vsyears) (adjusted relative risk [aRR] 2.14; P = 0.009) and on antiretroviral treatment longer (≥2 vsyears) (aRR 3.97; P < 0.001). Over the 2‐year follow‐up, 35 (29%) ENL had recurrent CIN2+ after TH compared to 19 (24%) ECL after LEEP (hazard ratio 1.32; 95% confidence interval 0.75–2.31; P = 0.338).
Conclusion: Among HIV‐infected women, adding ECC did not increase detection of pre‐cancerous disease significantly and treatment with LEEP+TH for ENL was comparable to treatment with LEEP for ECL.
International Journal of Gynecology & Obstetrics
Chung, M. H.,
Vuyst, H. D.,
Greene, S. A.,
Topazian, H. M.,
Malava, E. N.,
(2021). Loop electrosurgical excision procedure (LEEP) plus top hat for HIV‐infected women with endocervical intraepithelial neoplasia in Kenya. International Journal of Gynecology & Obstetrics, 152(1), 118-124.
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_obstet_gynaecol/281