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

Abstract

CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS:The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.reSUMO CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp

Twenty-Year Experience with Large Loop Excision of the Transformation Zone at Sestre Milosrdnice University Hospital Centre

“…The most compromised margins in our study were endocervical margins (80%), as in other studies in the literature 13 . Although the finding of endocervical positive margins is of greater concern, it need not necessarily confirm the presence of residual disease 10,13,14 .…”

Modified method of cervical conization with hybrid use of a cold knife and an electric knife for high-grade squamous intraepithelial lesions

“…Bittencourt et al reported that severe artifacts occurred in 22.8% of their patients. 23 The hybrid use of cold and electric knives in our method was designed to address the thermal artifact caused by the energy device and its adverse effect on pathological interpretation. The cold knife was used at the external and internal margin of the specimen of conization.…”

The Role of Surgeonsʼ Colposcopic Experience in Obtaining Adequate Samples by Large Loop Excision of the Transformation Zone in Women of Reproductive Age

“…The difficulties in margin assessment due to the presence of artifacts are also de-scribed, particularly from the pathologistsʼ point of view [8]. Surgical textbooks and publications often underline the significant influence of surgical experience on surgery results [6,14]. Nevertheless, surgical experience is not the only determining factor of LLETZ specimen quality.…”

“…Based on the recommendations of the National Health Service Cervical Screening Programme from the United Kingdom, at least 80 % of the LLETZ procedures should result in single piece specimen, which is a marker of good practice [23]. Still, the rate of single fragment LLETZ cones in literature ranges from 49 to 92% [2,6]. The trainee status in colposcopy was previously established to be a substantial risk factor for specimen fragmentation [3].…”

“…Unlike ablative methods, LLETZ allows histological examination of the excised tissue [1][2][3][4]. However, LLETZ causes thermal damage of specimens [5], due to the use of electricity, which simultaneously cuts and coagulates the tissue [6]. Thermal artifacts interfere with the pathological analysis [7].…”