Histometry of High-grade Cervical Intraepithelial Neoplasia and LEEP Excision Margin in HIV-infected and Uninfected Women

OBJECTIVE: To investigate whether the size of the lesion correlates with the completeness of excision, and whether human immunodeficiency virus (HIV) infection was a risk factor for incompleteness of excision. We investigated the size of high-grade cervical intraepithelial lesions of loop electrosurgical excision procedure (LEEP) specimens to assess its effect on the status of the excision margins. Because of the possible negative effect of HIV infection on the completeness of excision, we compared HIV-positive with HIV-negative cases. STUDY DESIGN: Cross-sectional study of 226 consecutive LEEP specimens with cervical intraepithelial neoplasia (CIN). There were 126 CINs >= 2; 59 (46.8%) were HIV positive. We measured the linear surface, the number of involved crypts, and the number of step sections involved by CIN >= 2. RESULTS: The excision margins were involved in 65.1%. The measurable linear extent and the average number of involved crypts and sections were significantly higher with incomplete excision (p < 0.0001, p = 0.001, and p = 0.02, respectively). The endocervical excision margin was involved in 52.4% of incomplete excisions. The excision was incomplete in 43.9% of HIV-infected and 56.1% of HIV-uninfected cases (chi(2) = 0.03, p = 0.88). CONCLUSION: It appears that instead of the linear surface involvement, it is rather the location in the endocervix and the extension inside the crypts that affects the excision margin status. HIV infection did not affect the completeness of excision.