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Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town
Thesis (MMed) -- Stellenbosch University, 2022.
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| Format: | Thesis |
| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2022
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| _version_ | 1867613989264949248 |
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| access_status_str | Open Access |
| author | Olujobi, Victor |
| author2 | Botha, Matthys Hendrik |
| author_browse | Botha, Matthys Hendrik Olujobi, Victor |
| author_facet | Botha, Matthys Hendrik Olujobi, Victor |
| author_sort | Olujobi, Victor |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed) -- Stellenbosch University, 2022. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/126024 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:44:53.996Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/126024 Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town Olujobi, Victor Botha, Matthys Hendrik Precancerous conditions -- South Africa -- Cape Town Cervix uteri -- Diseases -- South Africa -- Cape Town Colposcopy -- South Africa -- Cape Town Cervical intraepithelial neoplasia -- South Africa -- Cape Town Squamous cell carcinoma -- South Africa -- Cape Town UCTD Thesis (MMed) -- Stellenbosch University, 2022. ENGLISH ABSTRACT: Background Large loop excision of the transformation zone (LLETZ) has become widely accepted as the technique of choice for the treatment of cervical intraepithelial neoplasia. Despite its high efficacy in preventing cervical cancer, variable rates of post-LLETZ residual/recurrent high-grade squamous intraepithelial lesion (HSIL), also known as treatment failure is reported globally. This study was conducted to determine the prevalence of treatment failure within two years of LLETZ treatment for HSIL at Tygerberg hospital. Aim To determine the proportion of women treated for high-grade cervical intraepithelial neoplasia who developed cytological HSIL within two years of LLETZ. Materials and Methods In this retrospective cohort study, the electronic medical records of the first 139 consecutive women who underwent LLETZ treatment in 2016 and had a final diagnosis of HSIL as well as at least one follow-up cytology within two years of LLETZ were reviewed. Setting: Tygerberg Hospital colposcopy clinic, one of two tertiary referral hospitals in Cape Town, South Africa. Results: The rate of recurrent HSIL at the first follow-up cytology after LLETZ was 17.3% (95% confidence interval [CI] 11.4 to 24.6). 68.3% of study participants had a normal cervical cytology at the first follow-up visit after LLETZ. LLETZ margins were positive for CIN2/CIN3 in 58.3% (81/139) of biopsies, with involvement of the endocervical margin in almost half of these cases. Age 40 and above was significantly associated with post-LLETZ HSIL recurrence (odds ratio [OR] = 2.7, 95% CI 1.03 to 7.07, p = 0.04). There was nonsignificant increase in the odds of post-LLETZ residual/recurrent HSIL among women living with HIV, (OR =2.0, 95% CI 0.68 to 6.10, p = 0.2). Also, a nonsignificant increase in treatment failure was found when cases with positive margins were compared with those with clear margins (OR = 2.3, 95% CI 0.69 to 7.53, p = 0.18), as well as when uncertain margin status was compared with clear margin status (OR = 1.27, 95% CI 0.20 to 8.10, p = 0.80). 16.7% (4/24) of treatment failure occurred among women with clear LLETZ margins, and no treatment failure was detected at follow-up when the ectocervical margin was the only involved margin. The rate of loss to follow-up for a second cytology within two years of LLETZ was 74.8%. Conclusions: Even though LETTZ is an effective modality for the treatment of CIN, one in six treated women develop treatment failure within two years of LLETZ. Women aged 40 and above at the time of LLETZ are at a higher risk of developing treatment failure. There is a high rate of loss to follow-up for a second cervical cytology in the study population. Key words: High grade squamous intra-epithelial lesion, large loop excision of the transformation zone, LEEP, residual, recurrent, cervical intraepithelial neoplasia, margin status, complete excision, recurrent, treatment failure, post-treatment disease. AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar. Masters 2022-11-19T12:44:38Z 2023-01-16T12:46:17Z 2022-11-19T12:44:38Z 2023-01-16T12:46:17Z 2022-11 Thesis http://hdl.handle.net/10019.1/126024 en_ZA Stellenbosch University xi, 32 pages : illustrations application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Precancerous conditions -- South Africa -- Cape Town Cervix uteri -- Diseases -- South Africa -- Cape Town Colposcopy -- South Africa -- Cape Town Cervical intraepithelial neoplasia -- South Africa -- Cape Town Squamous cell carcinoma -- South Africa -- Cape Town UCTD Olujobi, Victor Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town |
| title | Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town |
| title_full | Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town |
| title_fullStr | Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town |
| title_full_unstemmed | Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town |
| title_short | Prevalence of high-grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in Cape Town |
| title_sort | prevalence of high grade squamous intraepithelial lesion within two years of large loop excision of the transformation zone at a tertiary hospital colposcopy clinic in cape town |
| topic | Precancerous conditions -- South Africa -- Cape Town Cervix uteri -- Diseases -- South Africa -- Cape Town Colposcopy -- South Africa -- Cape Town Cervical intraepithelial neoplasia -- South Africa -- Cape Town Squamous cell carcinoma -- South Africa -- Cape Town UCTD |
| url | http://hdl.handle.net/10019.1/126024 |
| work_keys_str_mv | AT olujobivictor prevalenceofhighgradesquamousintraepitheliallesionwithintwoyearsoflargeloopexcisionofthetransformationzoneatatertiaryhospitalcolposcopyclinicincapetown |