Treatment failure following excision therapy of CIN: the impact of ă direct colposcopic vision during procedure

International audience; To assess whether the use of direct colposcopic vision during excision ă therapy of cervical intraepithelial neoplasia (CIN) has an impact on the ă risk of treatment failure. ă Data from 285 patients who had had excision therapy with proven CIN at ă specimen histological analysis were reviewed. Primary endpoint was the ă occurrence of post-treatment failure defined by the histological ă diagnosis of CIN 2-3 during follow-up. Data were analysed according to ă the use of colposcopy at the time of initial therapy of CIN. ă The use of direct colposcopic vision (DCV) resulted in a significant ă reduction in the mean height (p = 0.008) and diameter (p < 0.001) of the ă excised specimen. Patients' median follow-up was 28.4 (+/- 1.3) months. ă A total of 43 (15.2 %) patients were diagnosed with treatment failure. ă Compared to excisions performed without any use of colposcopy, DCV was ă not found to have any significant impact on the risk of treatment ă failure (HR: 0.58; 95 % CI 0.16-2.13, p = 0.412), neither when compared ă to excisions performed immediately after colposcopy (HR: 0.91; 95 % CI ă 0.47-1.79; p = 0.794). The only factors found to have a significant ă impact on the risk of treatment failure was the identification of clear ă margins (HR: 0.36; 95 %CI 0.19-0.69; p = 0.002) and the diameter of the ă surgical specimen (HR: 0.94; 95 %CI 0.89-0.99; p = 0.040). ă Although the use of DCV during excision therapy of CIN was associated ă with a significant reduction in the dimensions of the excised cervical ă specimen, it did not result in a significant change in the risk of ă treatment failure.