Clearance of high‐risk human papillomavirus in patients with cervical intraepithelial neoplasia 2–3 after the loop electrosurgical excision procedure with negative resection margins
Praew Sittichivapak, Pattama ChaopotongAbstract
Objective
This study aims to evaluate the longitudinal clearance rates of high‐risk human papillomavirus (hr‐HPV) and the incidence of clinical recurrence (defined by abnormal cytology or histologically confirmed cervical intraepithelial neoplasia; CIN) at 6 and 18 months post‐loop electrosurgical excision procedure (LEEP), characterizing the mathematical boundaries within the complete cohort.
Methods
A retrospective cohort study was conducted at Siriraj Hospital, Mahidol University. We evaluated the clinical records of 145 patients diagnosed with CIN 2–3 who underwent LEEP between January 2021 and December 2024, analyzing clearance and clinical outcomes over an 18‐month surveillance window.
Results
The baseline prevalence of hr‐HPV was 99.3% ( n = 144/145). At 6 months post‐LEEP, the type‐specific viral clearance rate was 74.3% ( n = 107/144). At 18 months, complete hr‐HPV negativity was 75.8% (47/62) among the evaluable subcohort, representing a conservative baseline minimum of 32.6% (47/144) when accounting for complete attrition bounds. The overall recurrence rate of CIN or cytological abnormalities was 11.1% (16/144). Notably, 15 of 16 recurrences were detected at the 6‐month interval, of which 73.3% (11/15) demonstrated concurrent hr‐HPV positivity ( P = 0.0001).
Conclusion
Loop electrosurgical excision procedure facilitates significant viral clearance, but persistent hr‐HPV serves as a potent biomarker for clinical recurrence. Implementing mandatory HPV‐based testing at the 6‐month follow‐up window optimizes risk stratification, providing critical data to guide surveillance in the presence of follow‐up limitations.