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LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training
Rasiah Bharathan1, Balvinder Sagoo1, Aravind Subramaniam1
1Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE UK.
Purpose:
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.
Method:
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.
Results:
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.
Conclusion:
Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6 months post treatment. Enhancing the colposcopy training may help improve clinical outcome.
