Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ): Does completeness of excision determine outcome?
Objectives: To evaluate the therapeutic and diagnostic potential of large loop excision of the transformation zone (LLETZ) in the management of cervical dysplasia (CD) when colposcopy is satisfactory; to determine if there is a relationship between completeness of excision and outcome. Study Design:...
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| Veröffentlicht in: | European journal of obstetrics & gynecology and reproductive biology 1998-05, Vol.78 (1), p.83-89 |
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| container_title | European journal of obstetrics & gynecology and reproductive biology |
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| creator | Herrero y Sáenz de Cabezón, Rafael Viela Sala, Constantino Subirats Gomis, Sandra Romaguera Lliso, Amparo Gómez Bellvert, Cristina |
| description | Objectives: To evaluate the therapeutic and diagnostic potential of large loop excision of the transformation zone (LLETZ) in the management of cervical dysplasia (CD) when colposcopy is satisfactory; to determine if there is a relationship between completeness of excision and outcome.
Study Design: Ninety loop diathermies performed in the management of CD were studied prospectively.
Results: Eighty (88.89%) were indicated due to a high grade CD, 7 (7.78%) due to a low grade CD and 3 LLETZ (3.35%) due to a cytology–biopsy discordance. The margins were free of disease on 69 occasions (76.67%); on 15 (16.67%) the margins were affected by the disease and on 6 (6.67%) they were not evaluable. Using the Kaplan-Meier approach to survival analysis, the cumulative probability of continuing free of disease at the end of our study (36 months) was 0.89. In the margins free of disease group, patients stayed free of disease for an average of 32.98 months, and the cumulative probability of continuing free of disease at 36 months was 0.97. In the affected-margins group, patients stayed free of disease for an average of 20.91 months and the cumulative probability of continuing free of disease at 36 months dropped to 0.70. In the unevaluable-margins group, patients stayed free of disease for an average of 19.50 months and the cumulative probability of continuing free of disease at 36 months dropped still further to 0.67. Applying the Mantel-Cox Log-Rank Test we obtained differences among these three groups that are statistically significant (
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| doi_str_mv | 10.1016/S0301-2115(98)00016-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_79900968</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0301211598000165</els_id><sourcerecordid>79900968</sourcerecordid><originalsourceid>FETCH-LOGICAL-e291t-b3154d01416c1307d047cbcb844b097415dc7469c0c2fef566070a97f204eaf53</originalsourceid><addsrcrecordid>eNo9kc2O1DAQhC0EWoaFR1jJB4R2D4F2YscxlxVahh9pJA4sFy6W43TAKImD7YwYHoTnxbMTzaml7q9K6ipCrhi8ZsDqN1-hAlaUjIlr1dwA5F0hHpENa2RZyFrwx2RzRp6SZzH-yhBUlbogF6oGwYXYkH_bvRkWk5yfqO-pxbB31gy0O8R5MNEZmgKaNOKUaHuggwk_kA7ezxT_WBdXWfqJmTNT7H0YT2Z__YT0erfb3n-_eUvfe4zU-nEeMOGEMR5VZ4cuL8PossAvKVN4-5w86c0Q8cU6L8m3D9v7u0_F7svHz3fvdgWWiqWirZjgHTDOassqkB1waVvbNpy3oCRnorOS18qCLXvsRV2DBKNkXwJH04vqkrw6-c7B_14wJj26aHEYzIR-iVoqBaDqJoNXK7i0I3Z6Dm404aDXIPP95Xo3MefX5zDyc2esLCuo5RG7PWGYn9o7DDpah5PFzgW0SXfeaQb6WLB-KFgf29Oq0Q8Fa1H9B5i1mMU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>79900968</pqid></control><display><type>article</type><title>Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ): Does completeness of excision determine outcome?</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Herrero y Sáenz de Cabezón, Rafael ; Viela Sala, Constantino ; Subirats Gomis, Sandra ; Romaguera Lliso, Amparo ; Gómez Bellvert, Cristina</creator><creatorcontrib>Herrero y Sáenz de Cabezón, Rafael ; Viela Sala, Constantino ; Subirats Gomis, Sandra ; Romaguera Lliso, Amparo ; Gómez Bellvert, Cristina</creatorcontrib><description>Objectives: To evaluate the therapeutic and diagnostic potential of large loop excision of the transformation zone (LLETZ) in the management of cervical dysplasia (CD) when colposcopy is satisfactory; to determine if there is a relationship between completeness of excision and outcome.
Study Design: Ninety loop diathermies performed in the management of CD were studied prospectively.
Results: Eighty (88.89%) were indicated due to a high grade CD, 7 (7.78%) due to a low grade CD and 3 LLETZ (3.35%) due to a cytology–biopsy discordance. The margins were free of disease on 69 occasions (76.67%); on 15 (16.67%) the margins were affected by the disease and on 6 (6.67%) they were not evaluable. Using the Kaplan-Meier approach to survival analysis, the cumulative probability of continuing free of disease at the end of our study (36 months) was 0.89. In the margins free of disease group, patients stayed free of disease for an average of 32.98 months, and the cumulative probability of continuing free of disease at 36 months was 0.97. In the affected-margins group, patients stayed free of disease for an average of 20.91 months and the cumulative probability of continuing free of disease at 36 months dropped to 0.70. In the unevaluable-margins group, patients stayed free of disease for an average of 19.50 months and the cumulative probability of continuing free of disease at 36 months dropped still further to 0.67. Applying the Mantel-Cox Log-Rank Test we obtained differences among these three groups that are statistically significant (
P<0.005).
Conclusions: LLETZ could be considered the treatment of choice for CD when colposcopy is satisfactory, as it is effective, simple, fast, inexpensive, unaggressive, and of low morbidity. It also permits adequate pathology reporting. When a pathology report states that the margins of the specimen are not free of disease or are not evaluable, special caution in follow-up may be warranted.</description><identifier>ISSN: 0301-2115</identifier><identifier>EISSN: 1872-7654</identifier><identifier>DOI: 10.1016/S0301-2115(98)00016-5</identifier><identifier>PMID: 9605455</identifier><identifier>CODEN: EOGRAL</identifier><language>eng</language><publisher>Shannon: Elsevier Ireland Ltd</publisher><subject>Adult ; Biological and medical sciences ; Cervical neoplasia ; Conisation ; Conization ; Female ; Female genital diseases ; Gynecology. Andrology. Obstetrics ; Humans ; Medical sciences ; Middle Aged ; Prospective Studies ; Squamous intraepithelial lesion ; Treatment ; Treatment Outcome ; Tumors ; Uterine Cervical Dysplasia - pathology ; Uterine Cervical Dysplasia - surgery</subject><ispartof>European journal of obstetrics & gynecology and reproductive biology, 1998-05, Vol.78 (1), p.83-89</ispartof><rights>1998 Elsevier Science Ireland Ltd</rights><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0301211598000165$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2230675$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9605455$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Herrero y Sáenz de Cabezón, Rafael</creatorcontrib><creatorcontrib>Viela Sala, Constantino</creatorcontrib><creatorcontrib>Subirats Gomis, Sandra</creatorcontrib><creatorcontrib>Romaguera Lliso, Amparo</creatorcontrib><creatorcontrib>Gómez Bellvert, Cristina</creatorcontrib><title>Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ): Does completeness of excision determine outcome?</title><title>European journal of obstetrics & gynecology and reproductive biology</title><addtitle>Eur J Obstet Gynecol Reprod Biol</addtitle><description>Objectives: To evaluate the therapeutic and diagnostic potential of large loop excision of the transformation zone (LLETZ) in the management of cervical dysplasia (CD) when colposcopy is satisfactory; to determine if there is a relationship between completeness of excision and outcome.
Study Design: Ninety loop diathermies performed in the management of CD were studied prospectively.
Results: Eighty (88.89%) were indicated due to a high grade CD, 7 (7.78%) due to a low grade CD and 3 LLETZ (3.35%) due to a cytology–biopsy discordance. The margins were free of disease on 69 occasions (76.67%); on 15 (16.67%) the margins were affected by the disease and on 6 (6.67%) they were not evaluable. Using the Kaplan-Meier approach to survival analysis, the cumulative probability of continuing free of disease at the end of our study (36 months) was 0.89. In the margins free of disease group, patients stayed free of disease for an average of 32.98 months, and the cumulative probability of continuing free of disease at 36 months was 0.97. In the affected-margins group, patients stayed free of disease for an average of 20.91 months and the cumulative probability of continuing free of disease at 36 months dropped to 0.70. In the unevaluable-margins group, patients stayed free of disease for an average of 19.50 months and the cumulative probability of continuing free of disease at 36 months dropped still further to 0.67. Applying the Mantel-Cox Log-Rank Test we obtained differences among these three groups that are statistically significant (
P<0.005).
Conclusions: LLETZ could be considered the treatment of choice for CD when colposcopy is satisfactory, as it is effective, simple, fast, inexpensive, unaggressive, and of low morbidity. It also permits adequate pathology reporting. When a pathology report states that the margins of the specimen are not free of disease or are not evaluable, special caution in follow-up may be warranted.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cervical neoplasia</subject><subject>Conisation</subject><subject>Conization</subject><subject>Female</subject><subject>Female genital diseases</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Squamous intraepithelial lesion</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Uterine Cervical Dysplasia - pathology</subject><subject>Uterine Cervical Dysplasia - surgery</subject><issn>0301-2115</issn><issn>1872-7654</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kc2O1DAQhC0EWoaFR1jJB4R2D4F2YscxlxVahh9pJA4sFy6W43TAKImD7YwYHoTnxbMTzaml7q9K6ipCrhi8ZsDqN1-hAlaUjIlr1dwA5F0hHpENa2RZyFrwx2RzRp6SZzH-yhBUlbogF6oGwYXYkH_bvRkWk5yfqO-pxbB31gy0O8R5MNEZmgKaNOKUaHuggwk_kA7ezxT_WBdXWfqJmTNT7H0YT2Z__YT0erfb3n-_eUvfe4zU-nEeMOGEMR5VZ4cuL8PossAvKVN4-5w86c0Q8cU6L8m3D9v7u0_F7svHz3fvdgWWiqWirZjgHTDOassqkB1waVvbNpy3oCRnorOS18qCLXvsRV2DBKNkXwJH04vqkrw6-c7B_14wJj26aHEYzIR-iVoqBaDqJoNXK7i0I3Z6Dm404aDXIPP95Xo3MefX5zDyc2esLCuo5RG7PWGYn9o7DDpah5PFzgW0SXfeaQb6WLB-KFgf29Oq0Q8Fa1H9B5i1mMU</recordid><startdate>19980501</startdate><enddate>19980501</enddate><creator>Herrero y Sáenz de Cabezón, Rafael</creator><creator>Viela Sala, Constantino</creator><creator>Subirats Gomis, Sandra</creator><creator>Romaguera Lliso, Amparo</creator><creator>Gómez Bellvert, Cristina</creator><general>Elsevier Ireland Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19980501</creationdate><title>Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ): Does completeness of excision determine outcome?</title><author>Herrero y Sáenz de Cabezón, Rafael ; Viela Sala, Constantino ; Subirats Gomis, Sandra ; Romaguera Lliso, Amparo ; Gómez Bellvert, Cristina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e291t-b3154d01416c1307d047cbcb844b097415dc7469c0c2fef566070a97f204eaf53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cervical neoplasia</topic><topic>Conisation</topic><topic>Conization</topic><topic>Female</topic><topic>Female genital diseases</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Squamous intraepithelial lesion</topic><topic>Treatment</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Uterine Cervical Dysplasia - pathology</topic><topic>Uterine Cervical Dysplasia - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Herrero y Sáenz de Cabezón, Rafael</creatorcontrib><creatorcontrib>Viela Sala, Constantino</creatorcontrib><creatorcontrib>Subirats Gomis, Sandra</creatorcontrib><creatorcontrib>Romaguera Lliso, Amparo</creatorcontrib><creatorcontrib>Gómez Bellvert, Cristina</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of obstetrics & gynecology and reproductive biology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herrero y Sáenz de Cabezón, Rafael</au><au>Viela Sala, Constantino</au><au>Subirats Gomis, Sandra</au><au>Romaguera Lliso, Amparo</au><au>Gómez Bellvert, Cristina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ): Does completeness of excision determine outcome?</atitle><jtitle>European journal of obstetrics & gynecology and reproductive biology</jtitle><addtitle>Eur J Obstet Gynecol Reprod Biol</addtitle><date>1998-05-01</date><risdate>1998</risdate><volume>78</volume><issue>1</issue><spage>83</spage><epage>89</epage><pages>83-89</pages><issn>0301-2115</issn><eissn>1872-7654</eissn><coden>EOGRAL</coden><abstract>Objectives: To evaluate the therapeutic and diagnostic potential of large loop excision of the transformation zone (LLETZ) in the management of cervical dysplasia (CD) when colposcopy is satisfactory; to determine if there is a relationship between completeness of excision and outcome.
Study Design: Ninety loop diathermies performed in the management of CD were studied prospectively.
Results: Eighty (88.89%) were indicated due to a high grade CD, 7 (7.78%) due to a low grade CD and 3 LLETZ (3.35%) due to a cytology–biopsy discordance. The margins were free of disease on 69 occasions (76.67%); on 15 (16.67%) the margins were affected by the disease and on 6 (6.67%) they were not evaluable. Using the Kaplan-Meier approach to survival analysis, the cumulative probability of continuing free of disease at the end of our study (36 months) was 0.89. In the margins free of disease group, patients stayed free of disease for an average of 32.98 months, and the cumulative probability of continuing free of disease at 36 months was 0.97. In the affected-margins group, patients stayed free of disease for an average of 20.91 months and the cumulative probability of continuing free of disease at 36 months dropped to 0.70. In the unevaluable-margins group, patients stayed free of disease for an average of 19.50 months and the cumulative probability of continuing free of disease at 36 months dropped still further to 0.67. Applying the Mantel-Cox Log-Rank Test we obtained differences among these three groups that are statistically significant (
P<0.005).
Conclusions: LLETZ could be considered the treatment of choice for CD when colposcopy is satisfactory, as it is effective, simple, fast, inexpensive, unaggressive, and of low morbidity. It also permits adequate pathology reporting. When a pathology report states that the margins of the specimen are not free of disease or are not evaluable, special caution in follow-up may be warranted.</abstract><cop>Shannon</cop><pub>Elsevier Ireland Ltd</pub><pmid>9605455</pmid><doi>10.1016/S0301-2115(98)00016-5</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 0301-2115 |
| ispartof | European journal of obstetrics & gynecology and reproductive biology, 1998-05, Vol.78 (1), p.83-89 |
| issn | 0301-2115 1872-7654 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Biological and medical sciences Cervical neoplasia Conisation Conization Female Female genital diseases Gynecology. Andrology. Obstetrics Humans Medical sciences Middle Aged Prospective Studies Squamous intraepithelial lesion Treatment Treatment Outcome Tumors Uterine Cervical Dysplasia - pathology Uterine Cervical Dysplasia - surgery |
| title | Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ): Does completeness of excision determine outcome? |
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