Abnormal cervical cytology following large loop excision of the transformation zone: a case controlled study

Abstract

Objectives To determine factors that may predict cytological outcome at 6 months following large loop excision of transformation zone (LLETZ) for cervical intra epithelial neoplasia (CIN) and to investigate the outcome in women with continuing cytological abnormality. Design Case controlled retrospective study. Setting Dudley Road Hospital, Birmingham and Midland Hospital for Women. Subjects Fifty‐eight women with abnormal follow up cytology and a control group of 116 women. Main outcome measures The relation between pretreatment and treatment factors and cytological outcome, and the relation between cytology and histology in women who had biopsies for persistent adnormal cytology. Results Univariate and stepwise logistic regression analysis showed that the number of sectors of atypical transformation zone (lesion size) and the excision margin status of the large loop excision specimen are of prognostic importance for the prediction of cytological abnormality at the 6 month follow up visit. Sixteen women have undergone further cervical biopsy. Of the five cases of persistent CIN, four had cytological changes showing moderate or severe dyskaryosis. Of the 11 women with koilocytosis or normal histology, 10 had mild dyskaryosis or borderline changes on their follow up cytology. Conclusion Lesion size and excision margin status are important correlates of follow up cytology when treating patients for CIN with LLETZ. All women with abnormal cervical cytology at follow up should undergo colposcopic assessment. Excision biopsy is indicated if follow up cytology shows moderate or severe dyskaryosis, especially if still present 12 months after treatment.

A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia

“…In a recent survey of colposcopy clinics in the United Kingdom, LLETZ was the most frequently used treatment method, employed in 60% of centres 2 ; 85% of gynaecologists in the United States currently use this procedure 3 . LLETZ is performed easily and quickly as an outpatient procedure, and both the costs and the short term outcome compare favourably with local destructive and other excisional techniques 4–7 . Limited information is available, however, on the longer term results following this treatment modality.…”

Tools for Post LEEP Surveillance

“…Women with larger lesions and margins involved with CIN at LEEP were more likely to have abnormal cervical cytology at follow-up visit (56). We have found that 47% of women with involved surgical margins experience recurrence of CIN (21).…”

Postprocedural pap smears: A LEEP of faith?

“…35,36 The artifacts related to LEEP can be divided into three broad categories, which are outlined in greater detail in Table VIII. In point of fact, it is well-recognized that therapy of any kind not only has localized effects on the target disease, but also affects adjacent nondisease tissues as well.…”