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

Abstract

There is insufficient reporting on the level of colposcopic training for the safe use of large loop excision of the transformation zone. The aim of this study was to perform a quality assessment of large loop excision of the transformation zone in women of reproductive age by evaluating the surgeons' colposcopic experience. A retrospective cohort study was performed on diagnostic or therapeutic large loop excision of the transformation zone. The following variables were analyzed: age, parity, indications for surgery, level of surgeon's colposcopic experience, definitive histological diagnosis, margin involvement, and the presence and type of artifacts interfering with the pathological interpretation. Patients were divided into three groups: group A - 75 patients treated by junior colposcopists; group B - 74 patients treated by experienced colposcopists, and group C - 117 patients treated by expert colposcopists. Regarding the presence and diagnostic significance of the artifacts the groups were significantly different. Inadequate samples were the least frequent in group C. Artifacts precluding histological diagnosis were the most common in group A. The margins were predominantly inconclusive in group A. A high rate of artifacts is a disadvantage of the large loop excision of the transformation zone performed by surgeons less skilled for colposcopy. Although large loop excision of the transformation zone is considered to be a minor surgery, skills in colposcopy are an essential prerequisite for optimal results.

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

“…It should also be considered that LLETZ is a minimally invasive technique, where it is desirable to balance maximal removal of dysplastic tissue with minimal cervical damage 17 . Sparic et al in their study conclude that expert colposcopists have a lower incidence of positive margins after LLETZ, as well as thermal artifacts 21 . Constant investment in education and training of medical staff can provide optimal results in the treatment of cervical dysplasia with LLETZ technique 22 .…”

Evaluation of surgery indication of cold knife conization and anatomopathological reports in patients with cervical squamous intraepithelial lesion or cervical cancer

“…Therefore, LLETZ has been gaining more attention for being a low-cost outpatient procedure performed under local anesthesia, which is relatively safe with low complication rates (Yap, Nathan & Farrell, 2020). It is important to highlight that LLETZ enables reliable histopathological diagnosis only if there is no fragmentation of the excised specimens, since the extensive thermal injury makes it difficult to interpret its margins (Teixeira et al, 2018;Sparić et al, 2016).…”

The value of endocervical curettage during loop electrosurgical excision procedures in predicting persistent/recurrent preinvasive cervical disease

“…Lugol staining rather than colposcopy guidance was used to delimit the lesions. To ensure adequate diagnosis/treatment, all women were managed by gynecologic oncologists and gynecologic pathologists …”