Journal article

Outcomes of Loop Electrosurgical Excision Procedures Performed for Severe Cervical Dysplasia in Botswana


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Author list: Bazzett-Matabele L, Gupta M, Macduffie E, George J, Ball J, Hazan J, Narasimhamurthy M, Maoto-Mokote A, Seiphetlheng A, Monare B, Luckett R, Ramogola-Masire D, Grover S

Publisher: LIPPINCOTT WILLIAMS & WILKINS

Publication year: 2025

Journal name in source: JCO GLOBAL ONCOLOGY

Volume number: 11



PURPOSE In Botswana, a see-and-treat approach to cervical cancer screening is taken. Our objective was to determine the number of loop electrosurgical excision procedures (LEEPs) performed for cervical intraepithelial neoplasia (CIN) 2/3 in Botswana, and follow-up rates and outcomes, among women with positive cervical margins. METHODS Data (patient age, HIV status, margin status, follow-up, and recurrence) from women who underwent LEEP with histologically confirmed CIN 2/3 between January 2014 and December 2015 were analyzed retrospectively. Histopathologic reports were reviewed at a central laboratory in Gaborone, Botswana. Follow-up and recurrence rates were summarized descriptively and compared according to HIV and margin statuses using chi-squared tests. RESULTS In total, 779 women (median age, 39.2 years) underwent LEEP showing CIN2/3; 638 (81.9\%) women had CIN3 and 390 (50.1\%) had positive LEEP margins (ectocervical, 186 {[}47.7\%]; endocervical {[}including with ectocervical], 204 {[}52.4\%]). Margin positivity was not associated with HIV status. Of women with positive endocervical margins followed at <= 1 and >1 year, 9.6\% and 48.3\%, respectively, had persistent CIN2/3 on repeat LEEP. Forty percent (90 of 204) of women with positive endocervical margins had no re-excision documented. CONCLUSION Most women who underwent LEEP had CIN3 and positive margins. Almost half with positive margins followed at >1 year after initial LEEP had CIN2/3 recurrence warranting further treatment; two thirds were not followed. Resources are needed to improve post-LEEP follow-up for women with margin positivity who require additional ablative/excisional procedures to reduce the cervical cancer burden in Botswana.


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Last updated on 2025-28-07 at 12:24