Is direct large loop electric excision for the transformation zone reasonable in the investigation of high-grade squamous intraepithelial lesions in cervical smears?
OBJECTIVE
To evaluate women with cytological high-grade squamous intraepithelial lesions (HGSIL) who received standard colposcopic evaluation and direct diagnostic large loop electric excision for the transformation zone (LLETZ) to determine the feasibility of using LLETZ alone (ie, skipping the colposcopic examination).


METHODS
From May 1999 to May 2001, 70 women, with the mean age of 49.58 years (range, 20-82 years) and with cervical HGSIL categorized by the Bethesda system were all evaluated by colposcopic evaluation and LLETZ. Cases with a satisfactory colposcopy examination were classified as group A and those with an unsatisfactory colposcopy examination were classified as group B. "Over-treatment" was determined if the women did not need further LLETZ for evaluation or management. "Under-treatment" was determined if treatment might be potentially inadequate or invasive cancer could be ruled out during a satisfactory colposcopic evaluation.


RESULTS
Group A consisted of ten women who were evaluated satisfactorily by colposcopy and group B consisted of 30 women who were not evaluated satisfactorily by colposcopy. Overall 8.6% of the patients (6/70) were considered "over-treated". The rate of over-treatment was 10.0% (4/40) in group A compared with 6.7% (2/30) in group B. In contrast, overall 10% of the patients (7/70) were considered "under-treated". The rate of under-treatment was 10% (1/40) in group A compared with 10% (3/30), in group B. The positive predictive values of group A and B were 90.6% and 88.0%, respectively. The negative predictive values were 33.2% and 40%, respectively.


CONCLUSIONS
Direct diagnostic and therapeutic LLETZ for the management of cervical HGSIL may be a better alternative to colposcopy. This method of treatment avoids the possibility of under-treatment and is associated with an acceptable over-treatment rate, especially for postmenopausal women with cytological HGSIL. LLETZ has a good diagnostic accuracy with minimal morbidity and, most importantly, may help reduce patient anxicty, although further studies are needed to directly examine this effect.
Ng
K Y
KY
Department of Obstetrics and Gynecology, Cardinal Tien Hospital and Fu Jen Catholic University School of Medicine, Hsin Tien City, Taipei Hsien, Taiwan, ROC.
Chang
C K
CK
Chen
J
J
Wang
P H
PH
Teng
S W
SW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003127:Colposcopy / Q000706:statistics & numerical data*; D003663:Decision Trees; D003695:Delivery of Health Care; D004598:Electrosurgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013624:Taiwan / Q000453:epidemiology; D013673:Technology Assessment, Biomedical; D019564:Unnecessary Procedures; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*