Comparison of conization and limited excision of the transformation zone (LETZ) in the treatment of squamous intraepithelial lesions (SIL) of the uterine cervix.
OBJECTIVE
To compare the treatment of squamous intraepithelial lesions of the uterine cervix using conization with limited excision of the transformation zone (LETZ).


METHODS
A retrospective study of 285 women who received surgical treatment for cervical SIL between 2003 and 2006 was carried out. Prior to treatment, all the women underwent cervicovaginal cytology, colposcopy, and HPV testing. The women whose histology showed the presence of high-grade SIL were then divided into two groups for purposes of comparison: those treated by conization, and those treated by LETZ.


RESULTS
In group 1 (treatment by conization), 92 women met the selection criteria, and in group 2 (treatment by LETZ) 33 women met the selection criteria. Histology results showed high-grade SIL involvement of the-cone biopsy surgical margins for 22 cases (23.9%) in group 1, and high-grade SIL involvement of the LETZ surgical margins for six cases (18.1%) in group 2. In 13 of the women in group 2, the indication for LETZ was persistent low-grade SIL.


CONCLUSIONS
The percentage of surgical margins involved was similar in the two groups in our study, and comparable to that reported in the literature (16.2 to 26.6%). Our study, like other published studies, thus supports the possibility in certain cases of treating high-grade cervical SIL conservatively with LETZ or minicones. In the 13 women with a diagnosis of persistent low-grade SIL, 11 of whom (84.6%) were infected with a high-risk HPV genotype, LETZ made a diagnosis of occult high-grade SIL.


CONCLUSIONS
LETZ may be an alternative to conization in young women, and it is advisable in cases of persistent low-grade SIL with high-risk HPV infection.
González Bosquet
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E
Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, University of Barcelona, Spain. edugonzalez@hsjdbcn.org
Esteva
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C
Muñoz-Almagro
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C
Lailla
J M
JM
D052685:Alphapapillomavirus / Q000235:genetics / Q000472:pathogenicity*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000821:virology; D019092:Conization / Q000379:methods*; D005260:Female; D005838:Genotype; D006801:Humans; D030361:Papillomavirus Infections / Q000601:surgery*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery* / Q000821:virology