Efficacy of Large Loop Excision of the Transformation Zone for Cervical Intraepithelial Neoplasia

Chia, K. V.; Fayle, R. J. S.; Sobowale, O. A.

doi:10.1111/j.1479-828x.1993.tb02089.x

Cited by 10 publications

(10 citation statements)

References 9 publications

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“…The finding of 1.4% of patients with microinvasive carcinoma of cervix on histology stresses the need for thorough histological assessment. The diagnosis of 2 patients with microinvasive carcinoma cervix on interval LLETZ who had only CIN on punch biopsy corroborates the view that simple punch biopsy is inadequate for definite exclusion of invasive or severe cytological abnormality (1 [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Early invasive disease may occur without any detectable changes in the visible surface epithelium.…”

Section: Discussionsupporting

confidence: 55%

“…LLETZ diagnoses more microinvasive diseases than punch biopsy (20). LLETZ should be the preferred method of treatment instead of the local ablative techniques as this provides the opportunity to study the exact type of lesion, including its dimensions, that is not possible with local ablative techniques (4,19). Local ablation following cervical punch biopsy may leave a small number of women with an advanced lesion inadequately diagnosed and treated.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Treatment of Cervical Intraepithelial Neoplasia in a Single Visit

Das

Elias

1998

Aust NZ J Obst Gynaeco

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We evaluated the diagnostic and therapeutic efficacy of large loop excision of the transformation zone (LLETZ) performed in the first visit (see and treat policy) as compared to LLETZ treatment performed as an interval procedure. Data of 248 patients were analyzed of which 206 patients had LLETZ. Two thirds of the procedures were performed at the first visit. Of all the women who had the 'see and treat policy' 94.9% were diagnosed to have cervical intraepithelial neoplasia (CIN) on histology compared to 90.8% in the interval treatment group. A total of 3 (1.4%) patients were detected to have microinvasive carcinoma. There was no difference in the immediate postoperative complication rate, overtreatment rate and need of repeat treatment in both the groups. Single visit colposcopy and loop treatment is a safe and effective option for treatment of cervical epithelial abnormalities. The experience of the colposcopist is very important.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Cervical Intraepithelial Neoplasia in a Single Visit

Das

Elias

1998

Aust NZ J Obst Gynaeco

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“…The observations of Holowaty et al15 suggest that progression is a relatively slow process, with the risk of progression from CIN‐I to CIN‐III or cervical cancer being only 1% per year and the risk of progression from CIN‐II to CIN‐III being 16% within 2 years. The possibility of biopsy sampling error is supported by the observation of Chia et al16 of a large disparity in histologic findings between colposcopically directed punch biopsies and LLETZ samples.…”

Section: Discussionmentioning

confidence: 96%

A randomised, double‐blind, placebo‐controlled trial of photodynamic therapy using 5‐aminolaevulinic acid for the treatment of cervical intraepithelial neoplasia

Barnett

Haller

Cairnduff³

et al. 2002

Intl Journal of Cancer

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Photodynamic therapy (PDT) using topical 5-aminolaevulinic acid (ALA) has been used to treat histologically confirmed cervical intraepithelial neoplasia (CIN-I and -I/II) in a randomised, double-blind, placebo-controlled protocol. Fluorescence microscopy revealed that topical application of 3% ALA in Intrasite Gelா to the cervix for 3 hr resulted in the accumulation of protoporphyrin IX in the cervical epithelium. Treatment of CIN with ALA-PDT was well tolerated, with only 3/12 patients in the PDT arm (0/13 in the placebo arm) reporting any discomfort during illumination. Histologic examination of the treated tissue following loop excision 3 months post-PDT indicated that 33% of patients had no evidence of CIN, 42% had no change in the grade of their disease, whilst 25% exhibited an apparent progression of disease. In the control group, the respective figures were 31%, 38% and 31%. There was no significant difference in response between the groups receiving ALA-PDT and those receiving placebo treatment.

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“…[1][2][3][4][5][6] It allows a rapid, safe, and cost-effective alternative for diagnosing and treating cervical disease. [12][13][14][15][16][17][18] Most importantly, the procedure can be performed in an outpatient setting with a minimal risk of bleeding or excessive tissue damage. [12][13][14][15][16][17][18] Most importantly, the procedure can be performed in an outpatient setting with a minimal risk of bleeding or excessive tissue damage.…”

Section: Advantages and Disadvantagesmentioning

confidence: 99%

Postprocedural pap smears: A LEEP of faith?

1997

Diagn. Cytopathol.

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Loop electrosurgical excision procedure (LEEP) is gaining in popularity in the United States as an outpatient alternative to the diagnosis, and potentially the treatment, of cervical intraepithelial neoplasia (CIN). LEEP is fast, simple, performed under local anesthesia, readily learned, and without significant morbidity. As cytopathologists and cytotechnologists, immediate cytologic evaluation of cervico‐vaginal smears following LEEP is not the routine; however, there are very specific artifacts, most of which are related to the transfer of thermal energy, which result from the procedure. It is important to recognize these cytomorphologic features for accurate interpretation. The indications and contraindications for LEEP are similar to those for other ablative or excisional procedures. There appears no sacrifice in the efficacy of diagnosing and treating CIN by this method. Factors predictive of disease clearance are as confounding as they are for any other cone procedure. At the University of Iowa Hospital and Clinics (UIHC), immediate post‐LEEP endocervical brush (PLEB) is often performed as a method of assessing the endocervical canal for residual disease or skip lesions. The most common cytomorphologic features observed are: “taffy‐pulled” nuclei in elongated endocervical cells; cell aggregates with coalesced cytoplasm; hockey stick nuclei; notched and enlarged nuclei; and, smudgy chromatin. The difficulties or most frequent diagnostic dilemmas in interpreting these smears initially include abundant blood and smudgy chromatin, often tempting an interpretation of “unsatisfactory”. However, careful study reveals that these changes are related to the nature of the procedure and reproducible. Recognition and familiarization of these features enables more accurate interpretation of PLEB cytology. The significance of abnormal PLEB, with regard to disease clearance, is still uncertain. Diagn. Cytopathol. 1997;17:440–446. © 1997 Wiley‐Liss, Inc.

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Efficacy of Large Loop Excision of the Transformation Zone for Cervical Intraepithelial Neoplasia

Cited by 10 publications

References 9 publications

Diagnosis and Treatment of Cervical Intraepithelial Neoplasia in a Single Visit

Diagnosis and Treatment of Cervical Intraepithelial Neoplasia in a Single Visit

A randomised, double‐blind, placebo‐controlled trial of photodynamic therapy using 5‐aminolaevulinic acid for the treatment of cervical intraepithelial neoplasia

Postprocedural pap smears: A LEEP of faith?

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