Artifact in cervical LLETZ specimens: correlation with follow-up

Area of Science:

• Gynecologic Pathology
• Cervical Pathology

Background:

• Cautery artifact is a common issue in surgical pathology specimens.
• Its impact on diagnosing cervical dysplasia and predicting follow-up in large loop excision of the transformation zone (LLETZ) is not well-documented.

Purpose of the Study:

• To evaluate the effect of cautery artifact on dysplasia diagnosis and follow-up prediction in LLETZ specimens.
• To compare LLETZ with cold knife conization (CKC) regarding artifact interference and predictive value of margins.

Main Methods:

• Retrospective analysis of 100 consecutive conization specimens (76 LLETZ, 24 CKC) with cytologic/histologic follow-up.
• Assessment of cautery artifact severity (1+, 2+, 3+) and its interference with diagnosis and margin assessment.
• Correlation of margin status, specimen fragmentation, and artifact with follow-up outcomes.

Main Results:

• All LLETZ specimens had artifact; 61% interfered with evaluation, 33% precluded diagnosis/grading.
• Fragmented LLETZ specimens had significantly more interfering artifact (77%) than single-piece specimens (39%).
• Positive margins in CKC (86%) and LLETZ (63%) predicted abnormal follow-up, but LLETZ margins were less reliable.
• Post-procedure endocervical curettage was not a good predictor of residual disease for either method.

Conclusions:

• Cautery artifact significantly compromises diagnostic accuracy and margin assessment in LLETZ specimens.
• Specimen fragmentation exacerbates artifact issues in LLETZ.
• CKC margin status is a more reliable predictor of abnormal follow-up than LLETZ.
• Pathologists should report specimen adequacy and artifact interference.