Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia
Keywords:
Conization, Cervical intraepithelial neoplasia, Colposcopy, Electrocoagulation, WomenAbstract
CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients’ mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.
Downloads
References
Sperli AE, Freitas JOG, Fischler R. Rinofima: tratamento com equipamento de alta frequência (radiofrequência) [Rhinophyma: treatment with high-frequency equipment (radiofrequency)]. Rev Bras Cir Plást. 2009;24(4):504-8.
Cartier R, Cartier I, Caldas IS. Colposcopia prática. 3a ed. São Paulo: Roca; 1994.
Prendiville W, Cullimore J, Norman S. Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol. 1989;96(9):1054-60.
Apgar BS, Wright TC Jr, Pfenninger JL. Loop electrosurgical excision for CIN. Am Fam Physician. 1992;46(2):505-20.
Dores GB. HPV na genitália feminina. Manual e guia prático de cirurgia de alta frequência. São Paulo: Multigraf Editora Ltda; 1994.
de Carbezón RH, Sala CV, Gomis SS, Lliso AR, Bellvert CG. Evaluation of cervicaldysplasiatreatmentbylargeloopexcisionofthetransformation zone (LLETZ). Does completeness of excision determine outcome? Eur J Obstet Gynecol Reprod Biol. 1998;78(1):83-9.
Dobbs SP, Asmussen T, Nunns D, et al. Does histological incomplete excision of cervical intraepithelial neoplasia following large loop excision of transformation zone increase recurrence rates? A six-year cytological follow-up. BJOG. 2000;107(10):1298-301.
Montz FJ, Holscheneider CH, Thompson LD. Large-loop excision of the transformation zone: effect on the pathologic interpretation of resection margins. Obstet Gynecol. 1993;81(6):976-82.
Naumann RW, Bell MC, Alvarez RD, et al. LLETZ is an acceptable alternative to diagnostic cold-knife conization. Gynecol Oncol. 1994;55(2):224-8.
Duggan BD, Felix JC, Muderspach LI, et al. Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study. Am J Obstet Gynecol. 1999;180(2 Pt 1):276-82.
Moore KN, Bannon RJ, Lanneau GS, et al. Cervical dysplasia among women over 35 years of age. Am J Obstet Gynecol. 2008;199(5):471.e1-5.
Chappatte OA, Byrne DL, Raju KS, Nayagan M, Kenney A. Histological differences between colposcopic-directed biopsy and loop excision of the transformation zone (LETZ): a cause for concern. Gynecol Oncol. 1991;43(1):46-50.
Oyesanya OA, Amerasinghe CN, Manning EA. Outpatient excision management of cervical intraepithelial neoplasia. A prospective, randomized comparison between loop diathermy excision and laser excisional conization. Am J Obstet Gynecol. 1993;168(2):485-8.
Gardeil F, Barry-Walsh C, Prendiville W, Clinch J, Turner MJ. Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III. Obstet Gynecol. 1997;89 (3):419-22.
Howe DT, Vicenti AC. Is large loop excision of the transformation zone (LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial neoplasia? Br J Obstet Gynaecol. 1991;98(6):588-91.
Mor-Yoseh S, Lopes A, Pearson S, Monaghan JM. Loop diathermy cone biopsy. Obstet Gynecol. 1990;75(5):884-6.
Flannelly G, Bolger B, Fawzi H, De Lopes AB, Monaghan JM. Follow up after LLETZ: could schedules be modified according to risk of recurrence? BJOG. 2001;108(10):1025-30.
Ramchandani SM, Houck KL, Hernandez E, Gaughan JP. Predicting persistentrecurrent disease in the cervix after excisional biopsy. MedGenMed. 2007;9(2):24.
Rema P, Suchetha S, Thara S, et al. Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting. Int J Gynaecol Obstet. 2008;103(2):105-10.
Bozanović T, Ljubic A, Momcilov P, et al. Cold-knife conization versus the loop electrosurgical excision procedure for treatment cervical dysplasia. Eur J Gynaecol Oncol. 2008;29(1):83-5.
Shin JW, Rho HS, Park CY. Factors influencing the choice between cold knife conization and loop electrosurgical excisional procedure for the treatment of cervical intraepithelial neoplasia. J Obstet Gynaecol Res. 2009;35(1):126-30.
Jakus S, Edmonds P, Dunton C, King SA. Margin status and excision of cervical intraepithelial neoplasia: a review. Obstet Gynecol Surv. 2000;55(8):520-7.
Zaitoun AM, McKee G, Coppen MJ, Thomas SM, Wilson PO. Completeness of excision and follow-up cytology in patients treated with loop excision biopsy. J Clin Pathol. 2000;53(3):191-6.
Taha NSA, Focchi J, Ribalta JCL, et al. Avaliação do grau e da extensão das alterações térmicas produzidas pela cirurgia de alta freqüência no colo uterino [Evaluation of the intesity and the extensión of termal alterations produced by high frequency surgery in the uterine cervix]. Rev Bras Ginecol Obstet. 2001;23(1):47-51.
Spitzer M, Chernys AE, Seltzer VL. The use of large-loop excision of the transformation zone in an inner-city population. Obstet Gynecol. 1993;82(5):731-5.
Luesley DM, Cullimore J, Redman CW, et al. Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears. BMJ. 1990;300(6741):1690-3.
Mathevet P, DargentD, Roy M, Beau G. A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP. Gynecol Oncol. 1994;54(2):175-9.
Boardman LA, Steinhoff MM, Shackelton R, Weitzen S, Crowthers
L. A randomized trial of the Fischer cone biopsy excisor and loop electrosurgical excision procedure. Obstet Gynecol. 2004;104(4):745-50.
