Loop Excision Of Transformation Zone Research Articles

A portable thermal ablation device for cervical cancer prevention in a screen-and-treat setting: a randomized, noninferiority trial.

Implementing standard-of-care cryotherapy or electrosurgical excision to treat cervical precancers is challenging in resource-limited settings. An affordable technological alternative that is as effective as standard-of-care techniques would greatly improve access to treatment. This randomized controlled trial aims to demonstrate the noninferiority efficacy of a portable, battery-driven thermal ablation (TA) device compared to cryotherapy and electrosurgical excision (large loop excision of transformation zone (LLETZ)) to treat cervical precancer in a screen-and-treat program in Zambia. A total of 3,124 women positive on visual inspection with acetic acid and eligible for ablative therapy were randomized to one of the treatment arms. Human papillomavirus (HPV) testing was performed at baseline and at the follow-up. The primary outcome was treatment success, defined as either type-specific HPV clearance at the follow-up in participants positive for HPV at baseline, or a negative visual inspection with acetic acid test for those who had a negative HPV test at baseline. After a median follow-up of 12 months, treatment success rates were 74.0%, 71.1% and 71.4% for the TA, cryotherapy and LLETZ arms, respectively, thus demonstrating noninferiority (P = 0.83). TA was a safe and well-accepted procedure. Only 3.6% of those randomized to TA reported moderate-to-severe pain, compared to 6.5% and 1.9% for the cryotherapy and LLETZ arms, respectively. Thus, our randomized controlled trial demonstrates the safety and efficacy of TA, which is not inferior to cryotherapy or surgical excision.ClinicalTrials.gov registration: NCT02956239 .

Lugol's Solution Reduces Positive Margins and Residual Disease After the Large Loop Excision of Transformation Zone.

This study aimed to examine whether the intraoperative use of Lugol's solution reduces the proportion of positive resection margins (RMs) using the data of women who underwent large loop excision of the transformation zone (LLETZ). A total of 1,751 consecutive women with cervical intraepithelial neoplasia (CIN) who underwent LLETZ with or without Lugol's solution were retrospectively retrieved from each database of 3 university hospitals in South Korea. Outcomes included positive RMs and residual disease pathologically confirmed within 6 months after LLETZ. Positive RMs were noted in 345 cases (19.7%). Among 1,507 women followed up, residual disease was diagnosed in 100 cases (6.6%) (69/308 cases with positive RMs; 31/1,199 cases with negative RMs). The Lugol's solution group was less likely to have positive RMs (11.8% vs 25.5%, p < .01), to require additional surgical intervention (5.4% vs 10.2%, p < .01), and to have residual disease (4.9% vs 8.0%, p = .02). On multiple logistic regression analysis, Lugol's solution reduced the proportion of positive RMs (adjusted odds ratio [aOR], 0.31). Age (50 years or older; aOR, 1.64), preconization cervical cytology (aOR, 1.53), high-risk human papillomavirus (aOR, 1.75), and CIN 2 or 3 (aOR, 2.65) were independent risk factors for margin positivity ( p < .01 for all except high-risk human papillomavirus of p = .05). Lugol's solution optimizes CIN treatment by reducing the proportion of positive RMs and residual disease after LLETZ.

Factors associated with failed ‘test of cure’ in the NHS Cervical Screening Programme: A retrospective cohort study

ObjectiveTo determine predictive factors associated with failed ‘test of cure’ (TOC) in the NHS Cervical Screening Programme (NHSCSP). MethodsRetrospective cohort study of all patients treated by large loop excision of transformation zone (LLETZ) between 1st April 2014 and 1st April 2019. Those with no documented HPV genotype on referral, no TOC outcome, those having a hysterectomy, chemotherapy and/or radiotherapy were excluded from final analysis. ResultsPatients referred with a singular HPV genotype of HPV 16, HPV 18, or HPV Other types (HPV O) were significantly more likely to pass TOC than those referred with multiple HPV genotypes (p < 0.0001). Those with HPV genotypes including HPV O were significantly more likely to fail TOC as compared to those with genotypes of solely HPV 16 and/or 18 (p < 0.0001).Patients aged ≥51 years were significantly more likely to fail TOC when compared to all other age groups (p < 0.0001). ConclusionAge >51 yrs. and infection with multiple hr-HPV types were predictors of post treatment hr-HPV persistence. Knowledge of HPV genotype both at referral, and following treatment, could allow a more individualised, and patient-centred, approach to both the management and follow up of CIN. HPV genotype should be reported as standard on all cervical screening sample results. The term HPV O should not be utilised and instead actual HPV genotype should be reported. This would enable us to optimise not only future research but would also allow future monitoring of the efficacy of vaccination programmes.

Relationship between cervical excisional treatment for cervical intraepithelial neoplasia and obstetrical outcome.

The aim of our systematic review was the assessment of effects of excisional treatments for the management of cervical intraepithelial neoplasia (CIN) on preterm delivery (PD), lower birth weight (LBW), preterm premature rupture of membrane (PPROM) and obstetrical outcomes. A structured search was carried out in PubMed-Medline, Embase, and Cochrane Controlled Trials Register databases through November 30, 2019. The search included a combination of the following terms: "loop electrosurgical excision procedure (LEEP)," "large loop excision of transformation zone (LLETZ)," "cold-knife conization (CKC)," "laser cervical conization (CLC)," "preterm delivery" and "neonatal outcome." Thirty-two of 561 publications considered were included: 28 retrospective series, 2 prospective studies and 2 multicenter trials. Globally in several studies there was a significant increase in PD, measured by the relative risk, in the women underwent a surgical procedure for the CIN. In their majority, the studies were retrospective and therefore a high risk of bias. This systematic review shows that the surgical treatment of the CIN was associated with an increased risk of PD, LBW and pPROM before 37 pregnancy weeks compared to untreated women, especially in a CKC and LLETZ procedure. Moreover, the increase of the of PD was associated with cone size, cervical length, repeated treatment and a short conization-to-pregnancy interval.

Design and feasibility of a novel program of cervical screening in Nigeria: self-sampled HPV testing paired with visual triage

BackgroundAccelerated global control of cervical cancer would require primary prevention with human papillomavirus (HPV) vaccination in addition to novel screening program strategies that are simple, inexpensive, and effective. We present the feasibility and outcome of a community-based HPV self-sampled screening program.MethodsIn Ile Ife, Nigeria, 9406 women aged 30–49 years collected vaginal self-samples, which were tested for HPV in the local study laboratory using Hybrid Capture-2 (HC2) (Qiagen). HPV-positive women were referred to the colposcopy clinic. Gynecologist colposcopic impression dictated immediate management; biopsies were taken when definite acetowhitening was present to produce a histopathologic reference standard of precancer (and to determine final clinical management). Retrospective linkage to the medical records identified 442 of 9406 women living with HIV (WLWH).ResultsWith self-sampling, it was possible to screen more than 100 women per day per clinic. Following an audio-visual presentation and in-person instructions, overall acceptability of self-sampling was very high (81.2% women preferring self-sampling over clinician collection). HPV positivity was found in 17.3% of women. Intensive follow-up contributed to 85.9% attendance at the colposcopy clinic. Of those referred, 8.2% were initially treated with thermal ablation and 5.6% with large loop excision of transformation zone (LLETZ). Full visibility of the squamocolumnar junction, necessary for optimal visual triage and ablation, declined from 68.5% at age 30 to 35.4% at age 49. CIN2+ and CIN3+ (CIN- Cervical intraepithelial neoplasia), including five cancers, were identified by histology in 5.9 and 3.2% of the HPV-positive women, respectively (0.9 and 0.5% of the total screening population), leading to additional treatment as indicated. The prevalences of HPV infection and CIN2+ were substantially higher (40.5 and 2.5%, respectively) among WLWH. Colposcopic impression led to over- and under-treatment compared to the histopathology reference standard.ConclusionA cervical cancer screening program using self-sampled HPV testing, with colposcopic immediate management of women positive for HPV, proved feasible in Nigeria. Based on the collected specimens and images, we are now evaluating the use of a combination of partial HPV typing and automated visual evaluation (AVE) of cervical images to improve the accuracy of the screening program.

Efficacy of point-of-care thermal ablation among high-risk human papillomavirus positive women in China.

Thermal ablation is a point-of-care ablative treatment technique for cervical intraepithelial neoplasia (CIN). However, limited information is available about its efficacy in low- and middle-income countries. We evaluated the efficacy of thermal ablation in treatment of CIN detected through high-risk human papillomavirus (HPV) screening in China. Women positive on high-risk HPV and having colposcopically suspected lesions eligible for ablation underwent colposcopy, biopsy and thermal ablation in one visit. Women ineligible were recalled for large loop excision of transformation zone (LLETZ) when histopathology results were high-grade CIN. Posttreatment follow-up at 6 months or more was with HPV test and cytology followed by colposcopy and biopsy for HPV and/or cytology-positive women. Cure was defined as either negative cytology and HPV test or absence of histopathology proved CIN in any positive women. Of total 218 HPV-positive women treated with thermal ablation (n = 170) or LLETZ (n = 48), 196 reported for follow-up evaluation. For women with histologically confirmed CIN at baseline (thermal ablation-104; LLETZ-38), cure rates were 84.6% for thermal ablation and 86.8% for LLETZ. Cure rates after thermal ablation were 90.3% for CIN grade one (CIN1) and 76.2% for CIN grade two or worse (CIN2+). HPV clearance rate was 80.4% in women undergoing thermal ablation, which was lower for HPV16/18 compared to other oncogenic types (67.6% vs 85.7%). HPV test had a negative predictive value (NPV) of 98.7% to detect CIN2+ at follow-up and the positive predictive value (PPV) was 40.4%. Thermal ablation is effective to treat CIN as well as to clear the high-risk HPV infection. HPV test has high PPV and NPV in following up patients posttreatment.

Cold-knife conisation and large loop excision of transformation zone significantly increase the risk for spontaneous preterm birth: a population-based cohort study

ObjectivesOur aim was to explore the association between cold-knife conisation and large loop excision of transformation zone (LLETZ) with spontaneous preterm birth in a large 10-year national sample. We wanted to explore further the association of these procedures with preterm birth according to gestation. Study designWe conducted a population based retrospective cohort study, using data from national Medical Birth Registry. The study population consisted of all women giving birth to singletons in the period 2003–2012 in Slovenia, excluding all induced labors and elective cesarean sections before 37 weeks of gestation (N=192730). We compared the prevalence of spontaneous preterm births (before 28 weeks, before 32 weeks, before 34 weeks and before 37 weeks of gestation) in women with cold-knife conisation or LLETZ compared to women without history of conisation, calculating odds ratios (OR), adjusted for potential confounders. Chi-square test was used for descriptive analysis. Logistic regression analyses were performed to estimate crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals (95% CI) with two-sided probability (p) values. ResultsA total of 8420 (4.4%) women had a preterm birth before 37 weeks of gestation, 2250 (1.2%) before 34 weeks of gestation, 1333 (0.7%) before 32 weeks of gestation and 603 (0.3%) before 28 weeks of gestation. A total of 4580 (2.4%) women had some type of conisation in their medical history: 2083 (1.1%) had cold-knife conisation and 2498 (1.3%) had LLETZ. In women with history of cold-knife conisation, the adjusted OR for preterm birth before 37 weeks of gestation was 3.13 (95% CI; 2.74–3.57) and for preterm birth before 28 weeks of gestation 5.96 (95% CI; 4.3–8.3). In women with history of LLETZ, the adjusted OR was 1.95 (95% CI; 1.68–2.25) and 2.88 (95% CI; 1.87–4.43), respectively. ConclusionsWomen with cervical excision procedure of any kind have significantly increased odds for preterm birth, especially for preterm birth before 28 weeks and before 32 weeks of gestation.

Therapeutic Effectiveness of Large Loop Excision of Transformation Zone (LLETZ) in Management of Cervical Lesions

LLETZ is a simple, outpatient means of removing the transformation Zone or morbidity to the patient. The aim of our study was to evaluate the therapeutic effectiveness of LLETZ in management of cervical lesions. This prospective study was conducted at Department obstetrics & Gynecology Zenana Hospital, SMS Medical College, Jaipur from December 2014 to June 2015. The study includes all patients who attended colposcopy clinic with complaints of persistent leucorrhea, postcoital bleeding, intermenstrual bleeding and postmenopausal bleeding. We had 29 cases of chronic endocervicitis, 27 showed an inflammatory smear while 2 showed LGSIL. 3 patients showing HGSIL on pap smear showed CIN I on histopathology. This was false positive of Pap smear (6%). 1 patient of invasive squamous cell carcinoma showed HGSIL on pap smear. Thus LEEP was useful in diagnosing a case of invasive carcinoma which would have been missed with Pap smear alone. Also 3 patients of CIN II on biopsy had inflammatory (1) and LGSIL (2) on pap smear. LEEP (Loop Electrosurgical Excision Procedure) is a feasible management strategy for cervical lesions especially in developing countries like India where incidence of cervical carcinoma remains high because of ineffective screening and poor patient compliance for follow up.

Predictive value of volume of cervical tissue removed during LLETZ on subsequent preterm delivery: a cohort study

ObjectiveTo evaluate the impact of volume of tissue removed during large loop excision of transformation zone on subsequent preterm birth rates. Study designA retrospective cohort study was carried out in a single, large tertiary referral unit in UK. A total of 556 women who delivered between January 2008 and December 2011 following a previous large loop excision of transformation zone procedure or punch biopsy were identified from the maternity and colposcopy databases. Demographic data, gestational age at delivery, birthweight, neonatal outcome and dimensions of excised cervical specimen were collected. Pregnancy outcomes for women who had a previous loop excision were compared to a matched control group who had undergone punch biopsies only. ResultsThere was a significant increase in preterm birth rate in the large loop excision group compared to the control group (9.0% vs. 3.6%, respectively, RR 2.5, 95% CI 1.224–5.107). Women who had undergone at least one previous loop excision had more than a threefold increased risk of spontaneous preterm birth compared with their matched controls. However, no relationship between volume or depth of cervical tissue excised and subsequent gestation at delivery could be demonstrated. ConclusionsWhilst LLETZ is associated with an increased rate of preterm birth, the volume of tissue removed does not appear to influence the subsequent gestational age at delivery. This should reassure clinicians who should continue to perform LLETZ with adequate tissue margins to ensure complete resection of disease.

Multifocal FIGO Stage 1A1 Cervical Squamous Carcinomas have an Extremely Good Prognosis Equivalent to Unifocal Lesions

Early invasive squamous carcinomas of the cervix are sometimes multifocal. There are few guidelines regarding how to measure multifocal carcinomas and options include measuring from the edge of 1 invasive focus to the edge of the furthest invasive focus, adding the maximum horizontal dimension of each invasive focus together or regarding multiple foci as representing distinct small areas of invasion and if clearly separate measure them individually. For tumors with a shallow depth of invasion (<3 mm), this has implications for staging and management because if the maximum horizontal dimension is taken from the edge of 1 invasive focus to the edge of the furthest invasive focus, this could represent a International Federation of Gynaecology and Obstetrics (FIGO) 1B1 carcinoma, whereas alternatively these could be regarded as separate foci of 1A1 disease. It has been our practice to regard such lesions as representing multiple foci of invasion (multifocal FIGO 1A1 carcinomas) if clearly separate, arbitrarily defined by us as a minimum of 2 mm between each separate focus of invasion. In this study, we have obtained follow-up in a series of "multifocal 1A1 cervical squamous carcinomas" treated by local excisional methods (large loop excision of transformation zone or cone biopsy) with margins clear of premalignant and malignant disease. The study included 22 cases, 11 of which (50%) would have been regarded as FIGO stage 1B1 if the horizontal dimension had been measured from the edge of 1 invasive focus to the edge of the furthest invasive focus. In none of the cases was there evidence of recurrence of premalignant or malignant disease during follow-up (9-91 mo; mean and median 48 and 45.5 mo, respectively). Although limited by a relatively small number of cases, our results support the hypothesis that with regard to tumor staging and management, it is best to consider multifocal lesions as representing separate individual foci of invasion, to measure each focus separately, and to determine the FIGO stage on the basis of the highest FIGO stage of an individual focus.

PF.22 Establishing Normograms For Cervical Length in Pregnancy

ObjectiveTo construct normograms for cervical length in low-risk, singleton pregnancies from 14 weeks to 40 weeks gestation.Study designThis was a prospective, cross-sectional study involving low-risk women attending Cork University Maternity...

COMPARSION THE HISTOPATHOLOGICAL FINDINGS AFTER CERVICAL BIOPSY AND EXCISIONAL PROCEDURES

A definitive diagnosis of cervical intraepithelial neoplasia (CIN) is confirmed after histopathological (HP) examination of the tissue obtained through the biopsy. The aim of this study was to compare histopathological results obtained with punch biopsy and results obtained through one of the excisional techniques. We analysed histology results of 130 patients referred to our institution with abnormal smear. Punch biopsy was performed after colposcopic examination in all patients before one of the excision methods. Excision methods performed were: large loop excision of transformation zone (LLETZ), radio-frequency knife conisation or cold knife conisation. Based on the histopathological examination of the punch biopsy specimen or excisional specimen diagnosis of CIN was established. CIN and invasive cancer were the most common diagnoses in the 31-40 age group at 45.4% (59/130). Discrepancies in the histological diagnosis between punch biopsy and excisional biopsy was identified in 58.5% (76/130) of the patients. In 6% of the of the cases the biopsy did not detect an invasive carcinoma. The most frequent discrepancies between punch biopsy and excisional biopsy were in the group of patients with a higher grade cervical dysplasia. Mild dysplastic changes diagnosed through punch biopsy, require a more conservative approach, as the majority of this group had negative specimens on the cone after excision, especially in the younger population. It is advisable that the patients above 30 years of age and a higher grade dysplasia in the biopsy specimen, should undergo one of the excisional techniques as a diagnostic/therapeutic method of treatment.

Appropriate Cone Dimensions to Achieve Negative Excision Margins after Large Loop Excision of Transformation Zone in the Uterine Cervix for Cervical Intraepithelial Neoplasia

Aims: To determine appropriate cone dimensions for predicting margin status after large loop excision of transformation zone (LLETZ) treatment. Methods: An observational study performed at the Colposcopy Unit of a university hospital setting involving patients who underwent LLETZ conisation within a 1-year period. Data concerning the characteristics, cone dimensions, lesion grade and excision margins of the patients were recorded. Results: The median age of the women (n = 61) was 38 years (18-53). LLETZ cone specimens had 36.1% of cervical intraepithelial neoplasia (CIN)2/3 lesion and 13.1% positive margins. Mean cone depth and volume were 10.9 mm and 2.3 cm³, respectively. Multiple logistic regression for main predictors and after adjustment for age, parity and CIN severity showed that cone volume and length, cone base surface and proportion of excised volume had a significant effect on margin positivity. ROC analysis showed that optimal cut-off for cone volume was 2.1 cm³ (87.5% sensitivity - 54.7% specificity) or 8.6% of initial cervical volume (75% sensitivity - 75.5% specificity), and for cone length it was 10 mm (100% sensitivity - 52.8% specificity). Optimal cut-off for cone base surface as percentage of ectocervical surface was 32.7% (75% sensitivity - 69.8% specificity). Conclusions: These findings should be taken into consideration when planning the outer boundaries of excision and cervical tissue to be removed so as to achieve oncologically safe limits.

Endocervical crypt involvement by high‐grade cervical intraepithelial neoplasia after large loop excision of transformation zone: Do we need a different follow‐up strategy?

The aim of this study was to determine the effect of endocervical crypt involvement in specimens with clear margins on recurrence following large loop excision of transformation zone (LLETZ). This was an observational cohort study. In the colposcopy unit in a university teaching hospital we prospectively collected data for women who underwent LLETZ treatment for high-grade cervical intraepithelial neoplasia (CIN) between 2003 and 2004. We determined the difference in recurrence rate and need for repeat treatment between groups with and without crypt involvement in the primary histology. We prospectively collected data of follow up until 2010. The recurrence was analyzed using Cox regression. A total of 309 women had complete excision of the margins following LLETZ treatment for CIN 2 or 3. There was no significant difference in age between groups with (30.2) and without (29.7) crypt involvement (P<0.25). There was a significant difference in the prevalence of abnormal smear results before and after LLETZ between groups with or without crypt involvement (P=0.043). The need to perform a repeated treatment was significantly different between groups with and without crypt involvement (P<0.024). A full model significantly predicted recurrence of cervical pathology (P<0.009) that necessitated treatment when crypt involvement was present. The odds ratio for repeat treatment with crypt involvement was 2.67 (confidence interval, 1.27-5.64). Our study showed that positive involvement of endocervical crypt by CIN in a cervical loop excision specimen increases the frequency of subsequent episodes of treatment.

Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery

To investigate the association between previous large loop excision of transformation zone (LLETZ) and risk for subsequent spontaneous preterm delivery (sPD) and whether this effect is reflected in the measurement of cervical length at mid-gestation. A secondary analysis of data from women recruited for clinical trials of interventions to prevent preterm labour. A total of 26,867 women with singleton pregnancies attending for routine antenatal care. Transvaginal sonographic measurement of cervical length was carried out at 20(+0) to 24(+6) weeks. Logistic regression analysis was used to determine the significant predictors of sPD among maternal characteristics, obstetric history, previous history of LLETZ and cervical length. Spontaneous preterm delivery. In the 473 women who had undergone LLETZ, compared with the 25,772 without a history of LLETZ, the rate of sPD before 34 weeks of gestation was higher (3.4 versus 1.3%, P = 0.0002) and the median cervical length was shorter (32 mm versus 34 mm, P < 0.0001). Regression analysis demonstrated that in the prediction of sPD there were significant contributions from racial origin, cigarette smoking, previous preterm delivery and LLETZ and the detection rate of sPD was 29.8%, at a false-positive rate of 10%. However, after addition of cervical length, LLETZ did not remain a significant predictor in the model, which detected 52.6% of sPD, at a false-positive rate of 10%. LLETZ increases the risk of sPD, even after adjustment for maternal risk factors. The effect of a previous LLETZ on sPD in a subsequent pregnancy is reflected in the measurement of cervical length at mid-gestation.

Do FIGO Stage IA and Small (≤2 cm) IB1 Cervical Adenocarcinomas Have a Good Prognosis and Warrant Less Radical Surgery?

There is a controversy regarding the optimal management of small cervical adenocarcinomas, and more radical surgery is often undertaken compared to similar size squamous carcinomas. We wished to determine the risk of parametrial involvement and metastatic disease and the outcome in International Federation of Gynecology and Obstetrics (FIGO) stage IA and small (≤2 cm) stage IB1 cervical adenocarcinomas. All women with a diagnosis of International Federation of Gynecology and Obstetrics stages IA1, IA2, or IB1 cervical adenocarcinoma with a maximum tumor size of 2 cm were identified between 1999 and 2010 in Northern Ireland. A single pathologist reviewed all pathology prospectively at a cancer center tumor board. A total of 74 women were identified (mean age, 39 years; range, 25-72 years). In total, 36 women had stage IA1, 9 women had stage IA2, and 29 women had stage IB1 cervical adenocarcinomas. Surgical treatment ranged from local excision (cone or large loop excision of transformation zone) to radical hysterectomy and pelvic lymph node dissection; adjuvant therapy was not administered in any case. No parametrial involvement was seen in the 36 women who underwent parametrial resection. No lymph node metastasis was identified in the 45 women who underwent pelvic lymph node dissection. Lymphovascular space invasion was identified in 6 cases. No tumor recurrence or metastasis was noted during a mean follow-up of 35 months. The optimal management of women with IA or small IB1 cervical adenocarcinoma is controversial, and radical surgery is often undertaken. Our data suggest that there is an extremely low risk of parametrial and lymph node involvement with tumors 2 cm or smaller and a low recurrence rate. Less radical surgery may be warranted for small cervical adenocarcinomas, and this should be addressed by future studies.

Large loop excision of transformation zone procedures used in the management of cytological abnormalities of the cervix

National Health and Medical Research Council (NHMRC) guidelines published in 2005 changed the management of cervical squamous intraepithelial lesions. Asymptomatic low-grade abnormalities may be treated conservatively as many regress spontaneously. Cervical changes reflect infection with the human papilloma virus (HPV). Risk factors for acquiring HPV are the same as those for other sexually transmitted infections (STIs). To perform a comparison of the Papanicolaou (PAP) smear, histology results of the cervical biopsy and large loop excision of transformation zone (LLETZ) to determine what proportion were over treated, and conversely what proportion would have been under treated in relation to the 2005 NHMRC guidelines. This group of patients was reviewed also for history of STI or concurrent infection. Retrospective chart audit of LLETZ procedures and related histology in a population of women under 25 years between 1999 and 2003 presenting to a colposcopy clinic at a regional hospital. Two hundred and fifty-one asymptomatic women underwent LLETZ procedures. Of them, 27.6% reported a history of STI and 9.2% had a positive test result or history of Chlamydia. Based on the 2005 NHMRC guidelines, which require high-grade squamous intraepithelial lesions (HSIL) on PAP or biopsy, 34% of women had no indication for LLETZ. Of these, 65% were over treated having no HSIL on LLETZ histology and 35% would have been under treated. The 2005 NHMRC guidelines should result in 33.9% fewer LLETZ procedures being performed in the younger age group. This has benefits for their future fertility needs. STI screening would be beneficial in this group when seen at colposcopy clinics, as they have significant rates of prior or current infection.

Pregnancy outcomes after large loop excision of transformation zone of cervix

Since its introduction in1989, large loop excision of transformation zone (LLETZ) has been the most popular method used for the treatment of cervical intra-epithelial neoplasia (CIN). It has advantages like...

Situación de la conización del cuello uterino en el País Vasco

Objective The main objective of this study was to evaluate the conization technique used in Basque Country hospitals and to determinate the most appropriate place to perform this procedure (outpatient clinic or operating room) by evaluating pain, early and late complications and histological results. Materials and methods We selected 232 patients with a cytologic and colposcopic diagnosis of cervical dysplasia requiring surgical cervical conization between September 2006 and July 2007 in eight public hospitals of the Basque Country. Results A total of 94.8% of conizations were performed with long loop excision of transformation zone (LLETZ) and, exceptionally, with cold knife conization. Local anesthesia was used in tertiary hospitals and regional anesthesia in county hospitals. Pain tolerance in outpatient conization with LLETZ under local anesthesia was excellent. In Hospital Donostia, pain was scored on a visual analogue scale and low scores were achieved, in accordance with the high degree of satisfaction obtained with the procedure. Conization margins depended on the grade of dysplasia rather than on the technique. There were few early complications and even fewer late complications. Conclusion The LLETZ method performed under local anesthesia in the outpatient clinic is very well tolerated by patients and has few complications. Consequently, this option is a valid alternative to conization under general or regional anesthesia. The LLETZ technique provides multiple advantages for the patient and health service due to its lower cost, without medical disadvantages, and satisfactory tolerance.

Signet ring cells of stromal derivation in the uterine cervix secondary to cauterisation: report of a previously undescribed phenomenon

Aims:To describe the occurrence of signet ring cells of stromal origin within the uterine cervix.Methods:Following the identification of prominent signet ring cells in the stroma in a large loop excision...