LLETZ is an acceptable alternative to diagnostic cold-knife conization

Area of Science:

• Gynecology
• Surgical Pathology

Background:

• Cervical conization procedures, including cold-knife cone (CKC) biopsy, are standard for diagnosing and treating cervical dysplasia.
• Large loop excision of the transformation zone (LLETZ) offers a potentially less invasive method for obtaining cervical specimens.

Purpose of the Study:

• To evaluate Large loop excision of the transformation zone (LLETZ) as a viable alternative to traditional cold-knife conization (CKC) of the cervix.
• To assess the impact of LLETZ procedural variables on histopathologic diagnostic quality and patient outcomes.

Main Methods:

• One hundred twenty women underwent LLETZ procedures in an outpatient clinic under local anesthesia.
• Specimen quality, coagulation artifact, and the number of slices required for excision were analyzed.
• Correlation between the number of slices, heat artifact, and diagnostic interpretability was statistically assessed.

Main Results:

• LLETZ provided a pathologic specimen comparable to CKC, with only 1.8% of specimens showing diagnostic interference from coagulation artifact.
• A significant correlation was found between the number of slices used in LLETZ and increased heat artifact (P=0.02).
• The number of slices also significantly interfered with the pathologist's ability to determine complete excision of dysplasia (P=0.03).

Conclusions:

• Large loop excision of the transformation zone (LLETZ) is an acceptable and cost-effective alternative to diagnostic cold-knife conization (CKC).
• Minimizing the number of slices and maintaining specimen orientation are crucial for accurate histopathologic interpretation.
• Post-LLETZ endocervical curettage can identify patients at high risk for recurrent cervical intraepithelial neoplasia (CIN).