LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training.

Abstract

This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome. This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher's exact test was used. 75% of all specimens were obtained intact. When the LLETZ specimen was intact, 89% of smear tests were reported as negative, against 86% when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation. Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6months post treatment. Enhancing the colposcopy training may help improve clinical outcome.