Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.

Abstract

Objective-To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. Design-Prospective programme trial with six month follow up. Setting-Two hospital based colposcopy clinics. Patients-616 Patients aged 16-60 with abnormal cervical smears. Interventions-After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. Main outcome measures-Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. Results-Treatment was completed in a mean of 3-47 minutes (SD 1-99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4-4%. Conclusion-Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

“…However, one of its disadvantages is potential unnecessary treatments as claimed by other authors. 1,2,3,5,11 The traditional approach with a targeted biopsy for diagnostic confirmation requires more medical visits before the actual treatment of the lesions. 11 This causes increased anxiety to patients, which can in turn lead to dropout before treatment.…”

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

“…Here, 2.5% of the margins were damaged by artifacts, which is similar to the proportion found by other authors. 14,25,26 The literature presents many references to compromised margins, with percentages ranging from 0.0% to 30.5%, due to artifacts or fragmentation, thereby adversely affecting the histopathological interpretation. The highest rate (30.5%) was observed by Mathevet et al 27 in a study in which the equipment was not effective, and the physicians had various levels of experience with the procedure.…”

The psychological reaction of women to a colposcopy clinic

“…Several authors have expressed concern at the over-treatment rates obtained (as high as 49 %) when this practice is applied (Luesley et al 1990;Brady et al 1994). There is a significant morbidity, over and above that of simple colposcopy, such that women have every reason to be anxious about the introduction of this policy.…”