Large loop excision of the transformation zone (LLETZ): a pathology evaluation in the Limpopo province, South Africa
Keywords: cervix, high-grade intraepithelial lesion, large loop excision of the transformation zone
AbstractObjective: To evaluate the cytological and histopathological concordance in large loop excision of the transformation zone (LLETZ) specimens, and the outcomes according to the characteristics of the excision margins. Method: A prospective observational study of 413 consecutive cases of LLETZ performed for cytologically diagnosed high-grade squamous intraepithelial lesion (HGSIL)/cervical intraepithelial neoplasia (CIN) 2-3 over a three-year period. Results: The discordance rate between the initial cytological diagnosis and biopsy-proven HGSIL was 24.5%. The overall rate of margins believed to be clear and of severe thermal artefacts was 30.4% and 7.4% respectively. Pathology follow-up was available only in 83 (26.5%) of the 313 biopsy-confirmed HGSIL. The persistence or recurrence rate was 78.0%; 90.5% occurred among the cases where the margins were believed to be involved. In 20.5% the reported marginal status was discordant with follow-up surgical pathology. Conclusion: Reporting marginal status has limited prognostic significance.
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