engleski

LLETZ in the University Hospital 'Sestre milosrdnice', Zagreb, Croatia

Introduction : Large loop excision of the transformation zone (LLETZ) provides a pathologic specimen similar to a cold-knife cone (CKC) biopsy of the cervix. LLETZ is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy . Thermal coagulation necrosis caused LLETZ as well as detection of residual premalignant lesions after surgery are the main problems of this procedure. Objective: This study was conducted to review the 16-year experience of the use of large loop excision of the transformation zone (LLETZ) in our Hospital in order to prevent malignant lesions of the uterine cervix. Material and Methods : Retrospective study was performed through the period between years 1995 and 2011 including 1018 women with cervical dysplasia treated with LLETZ. Women were divided by age, cone biopsy histology results, biopsy results of the endocervical curettage specimen and the results of the cone margins histology. Results: Age distribution showed that LLETZ was most commonly performed in the age group 25-35 years (51% ; 514/1018), followed by the age group 36- 45 years (22% ; 220/1018), and the least commonly performed in the age group over 65 years (2% ; 18/1018). In the age group 25-35 years cone biopsy result CIN 2 or worse was present in 84% (431/514) of cases. In the age group 56-65 years cone biopsy result CIN 2 or worse was present only in 50% ( 9/18). Overall biopsy result lower than CIN 2 was found in 23% (232/1018) of patients, while CIN 2 or worse was present in 77% (786/1018) of patients. Only one patient, 0, 09% (1/1018), was diagnosed as invasive planocellular cancer. Residual dysplasia at the cone margins was found in 4, 2% (43/1018) of cases. Endocervical curettage histology result was positive in 10% (99/1018) of cases. Conclusion: LLETZ is highly effective, affordable and low-cost treatment option of the premalignant cervical lesions. However, it requires continuous education and training of the whole team. Colposcopy plays an important role when making the decision about the right type of treatment for the patient. Accurate colposcopic exam and findings help us avoid the overtreatment, which in our retrospective study was higher than we had expected. The aim of the new colposcopic classification ( IFCPC Rio Congress 2011) is towards to achieve better colposcopic diagnose in order to prevent as well overtreatment of low grade dysplasia as undertreatment of high grade dysplasia not recognized in cytological screening.

large loop excision of the transformation zone

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