Cervical Intraepithelial Neoplasia Grade 3 (CIN3) involves precancerous cell changes on the cervix that can develop into invasive cervical cancer if left untreated. The Loop Electrosurgical Excision Procedure (LEEP) is a standard and highly effective outpatient treatment for this condition. Although LEEP successfully removes these abnormal cells, it does not cure the underlying cause, meaning the precancerous condition can return. Understanding the procedure’s goal, recurrence factors, and necessary follow-up care is important for those who have undergone this treatment.
The Goal of the LEEP Procedure
The LEEP procedure aims to remove the entire area of abnormal tissue from the cervix in a single piece. This is done using a thin wire loop heated by an electrical current to precisely excise a cone-shaped section of the cervix. This excisional method functions both as a treatment to remove diseased tissue and as a diagnostic tool, providing a specimen for pathological examination.
The success of the procedure is determined by the status of the “surgical margins.” These margins are the edges of the removed tissue, representing the boundary between the excised tissue and the tissue remaining on the cervix. “Clear” or “negative” margins mean the pathologist found no abnormal CIN3 cells at the edges of the removed cone. Clear margins suggest all precancerous tissue was successfully removed, leading to an excellent prognosis and a lower chance of the disease persisting or recurring.
Understanding Recurrence Risk
Despite the high success rate of LEEP, CIN3 can return. This return is termed persistence if abnormal cells were left behind immediately after the procedure, or recurrence if a new lesion develops after a period of clear testing. The overall recurrence rate for high-grade lesions like CIN3 is typically between 1% and 14% within the first five years after treatment.
The status of the surgical margins is a strong predictor of the disease returning. If margins are “positive,” meaning abnormal cells were present at the edge of the removed tissue, there is a higher risk that precancerous tissue remains on the cervix. However, recurrence is still possible even with clear margins because the underlying cause of CIN3, the human papillomavirus (HPV), can persist.
Persistent infection with high-risk HPV types drives the development of new CIN lesions after treatment. LEEP removes the precancerous tissue but does not eliminate the virus itself. If the high-risk HPV infection continues, it can cause changes in other cervical cells over time. Other risk factors include the grade of the original lesion and whether the abnormal cells involved the glandular tissue of the cervix.
Post-LEEP Surveillance and Monitoring
Follow-up care is required after a LEEP procedure to detect any recurrence early. This surveillance protocol is more frequent than the standard cervical cancer screening schedule. The goal is to quickly catch any persistent or newly developed disease.
Standard follow-up generally begins six months after the LEEP procedure and involves co-testing. Co-testing combines cytology (Pap smear) and high-risk HPV testing. This combined approach is preferred because it provides a higher chance of detecting abnormal cells than using either test alone. If the initial six-month results are negative for both abnormal cells and high-risk HPV, testing is typically repeated annually.
Women treated for CIN3 remain at a higher risk for recurrence and cervical cancer for at least 20 years, even with initial negative results. Therefore, long-term surveillance is recommended, typically involving co-testing every one to three years for at least 25 years after successful treatment. Maintaining this structured monitoring schedule is the most effective way to manage the risk following a LEEP.
Next Steps If CIN3 Returns
If post-LEEP surveillance confirms the return of CIN3, the specific treatment approach is determined by the location and extent of the recurrence, the patient’s age, and their desire for future pregnancy. A common response to a small, localized recurrence is a repeat excisional procedure, such as another LEEP or a cold-knife cone biopsy.
Repeat excision procedures aim to remove the newly affected tissue while preserving healthy cervical tissue. For minor, surface recurrences, an ablative procedure like cryotherapy or laser therapy may be considered, which destroys the abnormal cells. Ablative methods are less common for CIN3 recurrence because excision allows for a new tissue sample to be examined.
Hysterectomy, the surgical removal of the uterus and cervix, is reserved for specific situations. This option may be considered for women with recurrent, persistent, or complex disease who have completed childbearing or when multiple prior excisional treatments have failed. Established and effective treatment options ensure the condition remains manageable.