Objective: Large loop excision of the transformation zone is more and more often used as a treatment for cervical intraepithelial neoplasia. There is still debate as to whether this method should be performed in cases when the lesion extends into the cervical canal. Some colposcopists consider loop excision equal to cone biopsy, while others confine its application to satisfactory colposcopy findings. The purpose of the study was to compare the effectiveness and morbidity of LLETZ performed due to CIN in patients with and without extension of the lesion into the cervical canal.
Design: Prospective study of 143 women treated by LLETZ due to cervical intraepithelial neoplasia.
Methods: A series of 143 patients cytologically and colposcopically suspected of cervical intraepithelial neoplasia received outpatient treatment by large loop excision of the transformation zone (LLETZ). Microcolpohysteroscopy examinations of the cervix were performed on all patients. Depending on the involvement of the endocervix the material was divided into two groups. Group A comprised 83 women with a colposcopically visible upper margin of the lesion. Group B consisted of 60 patients with the lesion ranging in the endocervix, but not exceeding 10 mm from the external os. Chi square analyses of indication, morbidity and recurrence of the lesions in the two groups were done. Results were considered significant at p less than 0.05.
Results: Minimal thermal damage of excised tissue did not interfere with histological examination in either group. In 139 cases (97.20%) histology examination confirmed the presence of CIN. There were no significant differences between the two treatment groups with respect to mean age, mean parity and indications for LLETZ. The women in the group with an entirely visible lesion experienced less perioperative blood loss. There was no significant difference in secondary haemorrhage, infection, stenosis, incomplete excision of the lesion, visibility of neosquamocolumnar junction and residual disease between the two groups.
Conclusions: On the basis of the results obtained it can be stated that LLETZ performed with colposcopic guidance complemented by microcolpohysteroscopy constitutes a valuable method in the treatment of CIN and it may in selected cases replace cone biopsy.