Journal of Lower Genital Tract Disease

Publisher: American Society for Colposcopy and Cervical Pathology, Lippincott, Williams & Wilkins

Journal description

The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology (ASCCP). ASCCP was established in 1964 and is dedicated to promoting education and research in the fields of colposcopy and cervical pathology. The Journal is peer-reviewed, and it publishes (1) original articles in basic science and clinical practice, (2) editorial comment, (3) invited and volunteer commentary, (4) review articles, (5) case reports, (6) correspondence, (7) book reviews, (8) instructional cases with photographs for the Home Study Course, (9) abstracts from relevant meetings, and (10) description of technique/technology. The Journal of Lower Genital Tract Disease is the source for the latest science in the field of diagnosis, etiology, and therapy of pathologic conditions of the cervix, vagina, and vulva. Its readers are members of the ASCCP and the International Federation of Cervical Pathology and Colposcopy (IFCPC) and interested individuals from many different disciplines including pathology, cytology, cytogenetics, gynecologic oncology, endocrinology, preventive medicine, basic science, and clinical medicine.

Current impact factor: 1.11

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.11
2012 Impact Factor 1.207
2011 Impact Factor 1.069
2010 Impact Factor 1.273

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.00
Cited half-life 4.90
Immediacy index 0.19
Eigenfactor 0.00
Article influence 0.00
Website Journal of Lower Genital Tract Disease website
Other titles Journal of lower genital tract disease (Online), Journal of lower genital tract disease
ISSN 1089-2591
OCLC 41986145
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Lippincott, Williams & Wilkins

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    • NIH authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 12 months embargo (see policy for details)
    • Wellcome Trust and HHMI authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 6 months embargo (see policy for details)
    • Publisher last reviewed on 19/03/2015
  • Classification
    ​ yellow

Publications in this journal

  • Journal of Lower Genital Tract Disease 01/2015; 19(1):e26. DOI:10.1097/LGT.0000000000000047
  • Journal of Lower Genital Tract Disease 01/2015; 19(1):e23. DOI:10.1097/LGT.0000000000000022
  • Journal of Lower Genital Tract Disease 01/2015; 19(1):e26-7. DOI:10.1097/LGT.0000000000000048
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    ABSTRACT: To compare the effectiveness of topical lidocaine spray compared to a placebo for relieving pain during colposcopic cervical biopsies and endocervical curettage. This randomized, placebo-controlled, double-blind study included patients with abnormal cervical cytologic results requiring colposcopy and directed cervical punch biopsy with or without endocervical curettage (ECC). The patients were randomly assigned to either the 10% lidocaine spray or the placebo group. The patients were asked to rate the pain level immediately after the cervical biopsy and ECC, and mean pain scores of the 2 groups were compared. A total of 214 women were included in the study: 104 in the lidocaine group and 110 in the control group. Age, parity, and history of previous vaginal delivery and cesarean section were similar in both groups. Mean ± SD age was 41.5 ± 10.6 years in the lidocaine group and 43 ± 11.3 years in the control group. Pain scores after cervical biopsy and ECC were also similar between the 2 groups. Mean ± SD pain scores associated with cervical biopsy were 2.18 ± 1.7 in the lidocaine group and 2.31 ± 1.6 in the control group. In our population, there is no evidence to recommend the use of routine locally sprayed lidocaine anesthesia before cervical punch biopsy or ECC.
    Journal of Lower Genital Tract Disease 12/2014; DOI:10.1097/LGT.0000000000000099
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    ABSTRACT: Women infected with human immunodeficiency virus (HIV) have a higher risk of HPV infections and developing cervical cancer, thus screening them is imperative. This study was aimed to evaluate and compare the performance of 3 cervical cancer screening options among HIV-infected women in Uganda. Data from 2,337 Ugandan women who reported their HIV status were obtained from a population-based cervical cancer screening study. Women were offered 3 screening tests: vaginal and cervical careHPV and visual inspection with acetic acid (VIA), and the results were evaluated by HIV status. The prevalence of HIV infection was 16.5%. Women infected with HIV had a higher prevalence of cervical intraepithelial neoplasia grade 2+ (CIN2+) than uninfected women (12.9% vs 1.7%; p < .001). The sensitivity for cervical careHPV among the HIV-infected women was 94.3% compared to 81.3% among the uninfected women. Whereas the sensitivity for vaginal careHPV was also higher among the HIV-infected women, the sensitivity of VIA was higher among the uninfected women. The mean vaginal and cervical careHPV signal strength was higher in the HIV-infected women than in the uninfected women (p < .001). CareHPV is very sensitive for detecting CIN2+ in HIV-infected women, even using a vaginal sample. The sensitivity of careHPV in HIV-infected women is higher than in HIV-uninfected women. However, additional research is needed to determine the best option for screening and triage of HPV-positive women that can be implemented in low-resource settings, especially among HIV- and HPV-positive women.
    Journal of Lower Genital Tract Disease 12/2014; DOI:10.1097/LGT.0000000000000090
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    ABSTRACT: Objective: To assess adherence to management guidelines based on the terminology used to describe atypical glandular cells (AGC) on cytology reports. Materials and Methods: We analyzed AGC pathology reports from Hartford Hospital, 2004-2007, and identified cases of AGC with the terminology atypical glandular cells or atypical endocervical cells (AEC). We calculated rates of clinical evaluations based on the terminology used to describe the AGC. Statistical analysis was performed using the [chi]2 test. Results: Seventy-eight reports contained the terminology AEC and 97 reports contained the terminology AGC. The rate of histologic sampling in women with AEC was lower than in women with AGC (52.6% vs 83.5%; p < .01). Similarly, the rate of comprehensive evaluations was lower (33.3% vs 71.1%; p < .01). Fewer endocervical curettages (47.4% vs 77.3%; p < .01) and fewer endometrial biopsies in women 35 years or older were performed (26.9% vs 69.1%; p < .01) in women with AEC than in women with AGC. Conclusions: Women with AGC reports containing the term AEC were managed less optimally than those with AGC. These results suggest that the terminology used to describe the finding of atypical glandular cells may influence the clinical evaluation. Clinicians may not recognize AEC as AGCs. Ours results suggest that the terminology atypical endocervical cells should be avoided or accompanied by the terminology atypical glandular cells. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 10/2014; DOI:10.1097/LGT.0000000000000089
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    ABSTRACT: Objective: To examine the influence of human papillomavirus (HPV) genotypes on the sensitivity of visual inspection with acetic acid (VIA) for screening, and colposcopy for diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe (CIN2+). Materials and Methods: Women aged 25 to 65 years from China (n = 7,541) were screened with 6 tests (careHPV and Hybrid Capture 2 on self- and clinician-collected specimens; HPV-16, HPV-18, HPV-45 E6 detection; and VIA). Biopsies from women with a diagnosis of CIN2+ underwent testing for 25 HPV genotypes using SPF10/LiPA. Human papillomavirus genotyping results were classified according to broad categories of cancer risk. Results: Among the 143 women with a diagnosis of CIN2+, the percentage who were HPV16 positive increased with increasing severity of diagnosis: 33.3% for CIN2 (n = 39), 69.1% for CIN3 (n = 94), and 90% for cancer (n = 10). There was a higher percentage of HPV-16 in women with abnormal colposcopic impression (p = .007) and positive VIA (p = .02) than normal colposcopy and negative VIA, respectively. Colposcopy and VIA were more sensitive to detect CIN2+ among HPV-16- and/or HPV-18-positive women than HPV-16-/HPV-18-negative women (67.4% vs 43.1%, p = .008, for colposcopy; and 53.3% vs 37.3%, p = .08, for VIA). Conclusions: Human papillomavirus type 16 is related to more clear visual acetowhite changes in the epithelium. Therefore, we should expect a reduction of the performance of VIA for cervical cancer screening to identify women with CIN2+, and reduction of the performance of colposcopy to diagnose CIN2+, in vaccinated populations. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 10/2014; DOI:10.1097/LGT.0000000000000088
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    ABSTRACT: Objective: This study aimed to observe the morphological characteristic of vaginal discharge in patients with cytolytic vaginosis (CV) under the microscope and to identify it in patients with CV and in patients with vulvovaginal candidiasis (VVC). Methods: A total of 108 subjects including 21 healthy women, 33 patients with CV, and 54 patients with VVC were enrolled in the present morphological study. Vaginal discharge was collected and made into smear. The morphological characteristics of these vaginal smears with Gram staining were observed under the microscope. The smears were assessed for the quantity of lactobacilli, epithelial cell morphology, and the absence or presence of Candida species, Trichomonas vaginalis, and clue sells. Results: First, the age, the level of education, and especially the status of pregnancy of patients with CV were significantly different from those of the patients with VVC. Second, the morphological characteristics of patients with CV consisted of overgrowth of lactobacilli, the presence of naked nuclei and fragments of the epithelial cells, a paucity of leukocytes, and the absence of Candida species and other pathogens. However, the morphological characteristic of patients with VVC consisted of the presence or absence of lactobacilli and the presence of normal epithelial cells, candidal spores, blastospores, hyphae, or other pathogens such as T. vaginalis and Gardnerella vaginalis. Conclusions: Both CV and VVC can be identified based on the quantity of lactobacilli, the morphology of the epithelial cells, and the absence or presence of Candida species and other pathogens, and the misdiagnosis of CV as VVC can be avoided. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 10/2014; DOI:10.1097/LGT.0000000000000076
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    ABSTRACT: Our objective was to evaluate the efficacy of conservative treatment with imiquimod in Paget vulvar disease.
    Journal of Lower Genital Tract Disease 10/2014; 18(4):347-50. DOI:10.1097/LGT.0000000000000053
  • Journal of Lower Genital Tract Disease 10/2014; 18(4):285. DOI:10.1097/LGT.0000000000000077
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    ABSTRACT: A multidisciplinary approach, including imaging, to evaluate and manage hydrostatic pelvic floor injuries is recommended.
    Journal of Lower Genital Tract Disease 09/2014; DOI:10.1097/LGT.0000000000000084
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    ABSTRACT: Objective: Our study evaluated the presence and predictors of sexual dysfunction in a vulvovaginal specialty clinic population. Materials and Methods: Women who presented to a vulvovaginal specialty clinic were eligible to enroll. The participants completed a questionnaire, including Female Sexual Function Index to assess sexual dysfunction and Patient Health Questionnaire (PHQ)-9 depression screen, and underwent a standardized physical examination, with vaginal swabs collected for wet mount and culture. Logistic regression assessed the relationship between sexual dysfunction and clinical diagnosis. Results: We enrolled 161 women, aged 18 to 80 years (median, 36 years), presenting with vulvovaginal complaints. Median symptom duration was 24 months; 131 women (81%) reported chronic symptoms (>=12 months). By PHQ-9, 28 women (17%) met depression criteria. In the month before assessment, 86 women (53%) experienced sexual dysfunction. Women had a primary diagnosis of vaginitis (n = 46 [29%]), vestibulodynia/vulvitis (n = 70 [43%]), lichen planus or lichen sclerosus (n = 24 [15%]). Controlling for age, we found that sexual dysfunction did not correlate with chronic symptoms (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.50-1.48), depression (IRR, 1.24; 95% CI, 0.59-2.58), or presence of any of the 3 main diagnoses (IRR, 1.16; 95% CI, 0.47-2.88). Discussion: Sexual dysfunction is present in more than half of women presenting to a vulvovaginitis referral clinic, more than twice the rate in the wider population. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 09/2014; DOI:10.1097/LGT.0000000000000085
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    ABSTRACT: Objective: We aimed to identify if there is any predictor of residual disease at repeat operation after cervical conization with positive surgical margins for high-grade squamous intraepithelial lesion (HSIL) or microinvasive cervical cancer. Materials and Methods: Records of patients who underwent immediate repeat conization or hysterectomy because of positive surgical margins for HSIL or microinvasive cervical cancer reported after conization were obtained. The relation between the residual disease and age, parity, menopausal status, and the factors of first conization (method, cone base area, height of cone, endocervical margin, glandular and endocervical curettage specimen involvement, and the number of quadrants with positive surgical margins) was assessed. Standard statistical tests were used. Results: Seventy-four patients were included. Mean time between the 2 operations was 5.1 weeks. Thirty-four patients (45.9%) had residual disease in the second-operation specimen: 4 low-grade squamous intraepithelial lesions, 24 HSILs, 5 microinvasive lesion, and 1 invasive cervical carcinoma. The number of involved quadrants was the only predictor of residual disease (41% if <=2 and 80% if >2, p = .02). Conclusions: Residual disease is found in nearly half of repeat operations after conization with positive margins for HSIL or microinvasive cervical cancer. Particularly, residual disease is present in 80% of the patients with more than 2 involved quadrants. This should be considered when making management decisions. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 09/2014; DOI:10.1097/LGT.0000000000000079
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    ABSTRACT: Objective: We conducted a pilot study of whether nonpathologists could accurately diagnose cervical precancer in biopsies using only a basic light microscope, evaluating p16INK4a immunohistochemistry (p16 IHC) of biopsies, and video-based training for both. Materials and Methods: Using biopsies collected as part of a screening study conducted in rural China, we randomly selected 50 biopsies with a precancerous diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe (CIN2+) and 50 biopsies with diagnosis of CIN less severe than CIN2, and stained them for p16 using a commercial IHC kit. Twelve nonpathologists of varying educational backgrounds living in Beijing, China received video training and were assigned one of 4 sets of 25 CIN2+ and 25 CIN less severe than CIN2 for evaluation. A pathologist reviewed all 100 cases. Results: The mean sensitivity and specificity of the p16 IHC staining scored by the nonpathologists were 91.7% and 94.1%, respectively, compared to scoring by the pathologist. The readers and the pathologist agreed on p16 IHC scoring for 42 (84%) of the 50 slides of CIN less severe than CIN2 and 37 (74%) of the 50 CIN2+ slides. The mean sensitivity and specificity for consensus CIN2+ of p16 IHC as scored by the readers were 88% and 87%, respectively, versus an overall sensitivity and specificity by the pathologist of 96% and 92%, respectively. Conclusions: We demonstrated that nonpathologists can accurately diagnose CIN2+ using p16 IHC alone. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000080
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    ABSTRACT: We investigated the clinical and demographic characteristics that could influence regression of cervical intraepithelial neoplasia (CIN) from colposcopy to excision, and evaluated the association of the performance of multiple biopsies and endocervical curettage (ECC) with regression of high-grade (CIN 2+) by the time of excisional therapy.
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000019
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    ABSTRACT: Objectives: We hypothesized that women with cervical cytologic results of high-grade squamous intraepithelial lesion (HSIL) and negative high-risk human papillomavirus (HR-HPV) test results would have a high risk of having endometrial cancer and would benefit from routine endometrial biopsy. Materials and Methods: Reports of women with cytologic results of HSIL and negative HR-HPV test results were found in an electronic colposcopy database; their charts were reviewed. Rates of endometrial cancer for cytologic results of HSIL and negative HR-HPV test results were compared to a historical series for cytologic results of HSIL with positive HR-HPV and cytologic results of atypical glandular cells (AGCs) and negative HR-HPV test results. Results: Between August 10, 1998, and April 20, 2013, 56 women were evaluated in our colposcopy clinics for cytologic results of HSIL and negative HR-HPV test results; of these 56 women, 1 (1.8%) was diagnosed with endometrial cancer. No endometrial cancer was diagnosed during the follow-up (median = 63 mo) after colposcopy. The risk for endometrial cancer with cytologic results of HSIL and negative HR-HPV test results (1.8%, 1/56) did not differ from that of a historical series from 2007 to 2009 from the same colposcopy clinic in 223 women with cytologic results of HSIL and positive HR-HPV test results (0.0%, 0/223; p = .2) and was lower than the risk for endometrial cancer from the historical series from 2007 to 2009 in women with cytologic results of AGC and negative HR-HPV test results (14.4%, 4/27; p = .04). Conclusions: Women with cytologic results of HSIL and negative HR-HPV test results are more like those with cytologic results of HSIL and positive HR-HPV test results than those with cytologic results of AGC and negative HR-HPV test results and would unlikely to benefit from routine endometrial biopsy at the time of colposcopy. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000072
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    ABSTRACT: Objective: To study the role of cervicovaginal infections in women with cytological reports of atypical squamous cells of undetermined significance (ASC-US). Materials and Methods: The study included 220 women admitted to the Clinic of Microscopy, Cervicovaginal and Vulvar Pathology of the Department of Gynecology and Obstetrics of the Tor Vergata University Hospital, Rome, Italy, enrolled between October 2012 and July 2013. Results: Among the enrolled women, 105 women (47.7%) had ASC-US cytology, whereas 115 women (52.3%) had negative cytology. Microscopy showed infections more frequently in women with ASC-US than in those with negative cytology: 70.5% (74/105) vs 36% (41/115); p < .001. Cocci were present in 73.3% (77/105) of the women with ASC-US and in 43.5% (50/115) of those with negative cytology; p < .001. According to Ison score, 84% (88/105) of ASC-US was grade 0 vs 22% (25/115) of negative cytology, p < .001. Human papillomavirus was detected in 35% of the women with ASC-US. A statistically significant correlation between high pH and vaginal infections was found in women aged 20 to 29 (p = .003) and those 50 years or older in both cytological report groups; p < .001. Conclusions: Cervicovaginal infections are associated with a cytological report of ASC-US. Direct microscopy of vaginal specimens allowing immediate evaluation of the vaginal microflora and infectious agents may be a useful tool in managing women with cytological reports of ASC-US. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000078
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    ABSTRACT: OBJECTIVE: Nonattendees to cervical cancer screening are at a higher risk of developing cervical cancer. This study assessed women's willingness to perform a home-based self-sampling for human papillomavirus testing (Self-HPV) and explored the feasibility of establishing a home-based Self-HPV screening strategy in Switzerland. MATERIALS AND METHODS: Underscreened women (n = 158) who had not underwent a Pap test in the preceding 3 years were recruited between September 2011 and September 2013. Participants completed 2 questionnaires evaluating reasons for non-attendance at a screening program, sociodemographic issues, and satisfaction with and acceptability of the Self-HPV. Descriptive data and multivariate logistic regression were used to identify variables associated with women's willingness to perform at-home self-sampling for HPV testing. RESULTS: Lack of time because of work or childcare was the most common reason for nonattendance at a screening program. One hundred six women (82%) preferred the Self-HPV because it is easy to perform, convenient, comfortable, and private. Women were more likely to accept the Self-HPV as a future screening strategy if they had missed cervical cancer screening in the past because of lack of time (odds ratio [OR] = 6.2, 95% confidence interval [CI] = 1.6-23.6; p < .01). Twenty-six women felt pain during self-sampling. Previous negative experiences with screening and stress during sampling were associated with higher risk for pain (OR = 7.14, 95% CI = 2.0-25.3, p < .01 and OR = 4.73, 95% CI = 1.5-14.5, p < .01, respectively). CONCLUSIONS: The Self-HPV was accepted by nonattendees of cervical cancer screening programs. Self-sampling may promote screening among the unscreened and underscreened population of women in Switzerland while overcoming some practical barriers.
    Journal of Lower Genital Tract Disease 08/2014; 19(1). DOI:10.1097/LGT.0000000000000051
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    ABSTRACT: Objective: Is it feasible to learn the basics of wet mount microscopy of vaginal fluid in 10 hours? Materials and Methods: This is a pilot project wherein 6 students with different grades of education were invited for being tested on their ability to read wet mount microscopic slides before and after 10 hours of hands-on training. Microscopy was performed according to a standard protocol (Femicare, Tienen, Belgium). Before and after training, all students had to evaluate a different set of 50 digital slides. Different diagnoses and microscopic patterns had to be scored. [kappa] indices were calculated compared with the expert reading. Results: All readers improved their mean scores significantly, especially for the most important types of altered flora (p < .0001). The mean increase in reading concordance ([kappa] from 0.64 to 0.75) of 1 student with a solid previous experience with microscopy did not reach statistical significance, but the remaining 5 students all improved their scores from poor performance (all [kappa] < 0.20) to moderate ([kappa] = 0.53, n = 1) to good ([kappa] > 0.61, n = 4) concordance. Reading quality improved and reached fair to good concordance on all microscopic items studied, except for the detection of parabasal cells and cytolytic flora. Conclusions: Although further improvement is still possible, a short training course of 10 hours enables vast improvement on wet mount microscopy accuracy and results in fair to good concordance of the most important variables of the vaginal flora compared to a reference reader. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000052
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    ABSTRACT: Objective: We sought to determine which clinical factors can predict this phenomenon and to better understand the clinical significance of negative loop electrosurgical excision procedure (LEEP) findings through long-term follow-up. Methods: We identified 559 patients with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or 3 (CIN 2, 3) who were treated by LEEP between February 2001 and December 2010. Preconization clinical characteristics, as well as high-risk human papillomavirus (hrHPV) status, were analyzed as possible predictors of an absence of a lesion in the specimen. The clinical significance of an absence of a lesion in the specimen, as well as other factors, was evaluated by Cox hazard regression analysis in terms of recurrence. Results: No lesion on the LEEP specimen was found in 102 (18.2%) of 559 patients with CIN 2,3 on punch biopsy. Punch biopsy status of CIN 2, low HPV viral load (<100 relative light units [RLU]), and negative or positive HPV infection other than type 16 were significantly related to no lesion in the LEEP specimen. Postoperative HPV persistence (>=10 RLU) and same-type HPV detection were significantly related to recurrent disease of CIN 2+ (p < .001). The recurrence of patients with no lesion in LEEP did not statistically differ from that of patients with a lesion in the LEEP specimen (p = .390). Conclusions: The absence of a lesion in the LEEP specimen is very common. A negative LEEP is associated with a persistence/recurrence rate similar to that of positive LEEP. We recommend that the follow-up for patients with no lesion in the LEEP specimen should be the same as that for patients with a lesion. Copyright (C) 2015 by the American Society for Colposcopy and Cervical Pathology
    Journal of Lower Genital Tract Disease 08/2014; DOI:10.1097/LGT.0000000000000061