Efficacy of contour-loop excision and conization of the cervix in high-grade squamous intraepithelial lesions

Background: At present, despite numerous excisional methods for the treatment of High-Grade Squamous Intraepithelial Lesion (HSIL), the rates of residual lesions and recurrences remain rather high, ranging from 30% to 50% regardless of the method chosen. Notably, up to 30% of women remain infected with human papillomavirus after surgical treatment. Therefore, the choice of the optimal excision technique for HSIL is still relevant, as it should reduce the incidence of residual lesions, disease recurrence, and human papillomavirus persistence.

Aim: The work aimed to evaluate the efficacy of contour-loop excision (C-LETZ) and classical cervical conization in HSIL.

Methods: In 2021–2023, at the Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, 66 patients with histologically confirmed HSIL were examined, treated, and followed up; classical cervical conization (group 1, n = 32) and contour-loop excision of the cervix using a wave-shaped C-LETZ cone (group 2, n = 34) were performed.

Results: Positive endocervical resection margins were observed more frequently after classical cervical conization compared with C-LETZ (р < 0.001). Conization more often revealed endocervical crypt involvement at the apex of the excised cone (р = 0.03), as well as the presence of HSIL in endocervical curettage (р = 0.01). In group 1, 8% of women had intraepithelial lesions confined to the endocervical curettage with no involvement in the resected specimens, compared with 0% in group 2. Residual lesions in group 1 were detected in 6% (2/32) within one year of follow-up and in 12% (4/32) between one and two years. Disease recurrence after two years of follow-up was diagnosed in 18% of women (6/32). In group 2, residual lesions were identified in 3% (1/34) within one year and in 6% (2/34) between one and two years. Recurrence after two years was three times less frequent compared with group 1—in 6% of women (2/34); p = 0.01.

Conclusion: Due to the wave-shaped structure of the C-LETZ loop, excision allows deeper capture of the endocervix, thereby increasing the volume of resected cervical canal tissue. This contributes to a twofold reduction in positive endocervical margins and human papillomavirus persistence, and a 1.5-fold reduction in residual crypt lesions compared with classical conization. Thus, deeper removal of endocervical tissue with C-LETZ reduces the risk of human papillomavirus persistence, residual lesions, and disease recurrence.