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Large loop excision of the transformation zone and cervical intraepithelial neoplasia: a 22-year experience
Sofia M Stasinou1, George Valasoulis, Maria Kyrgiou
1Department of Obstetrics and Gynaecology, Ioannina University Hospital, Ioannina, Greece. m.stasinou@yahoo.com.
Aim:
To review the 22-year experience of the use of large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN).
Design:
Retrospective observational study.
Setting:
University Hospital of Ioannina, Greece.
Period:
January 1989 until December 2011.
Population:
Women undergoing excisional treatment with LLETZ for CIN. Women with invasive disease were excluded.
Intervention:
Excisional treatment with LLETZ. Women had post-operative surveillance with cytology and colposcopy at 6, 12, 18 and 24 months, and yearly thereafter.
Outcomes:
We assessed the histological outcomes and margin involvement, as well as the rate of treatment failures requiring a repeat conization.
Results:
A total of 3861 LLETZ biopsies were recorded during the study period. The histological evaluation of the cone specimens showed CIN1 in 897 (23.2%), CIN2 in 1129 (29.3%), CIN3 in 1322 (34.2%), microinvasive disease in 158 (4.1%), HPV lesions in 206 (5.3%) and normal histological findings in 149 (3.9%) women. The margins were reported as clear in 3166 (82%) cases, involved in 437 (11.3%) cases and uncertain in 258 (6.7%) cases. A total of 239 (6.2%) women underwent a second conization due to treatment failure.
Conclusion:
LLETZ remains the most popular conservative technique of treatment for women with precancerous cervical lesions. Post-treatment surveillance of these women is essential in order to detect residual or recurrent disease. New HPV biomarkers, introduced over the last two years, appear to be useful in the follow-up after treatment. A scoring system may allow for accurate prediction of women at risk of treatment failure and for tailored post-treatment surveillance.