title: Indication and outcome of repeat large loop excision biopsies of the cervix.
abstract: BACKGROUND
  To investigate the indications for performing a second large loop excision of the transformation zone (LLETZ) biopsy and to compare the associated colposcopic and pathological findings and treatment morbidity compared with 1 LLETZ.
  
  
  METHODS
  This is a case-control study that reviewed case notes and histology reports on women who had undergone 1 LLETZ biopsy (control group) and women who had undergone 2 biopsies (index group). A comparison of referral cytology, colposcopic findings, and pathological and clinical outcomes was performed.
  
  
  RESULTS
  Of the women who went on to have 2 LLETZ biopsies, 88% had histologically proven high-grade cervical intraepithelial neoplasia (CIN) or invasion on their first biopsy. A significantly greater proportion of high-grade cytologic and histologic diagnoses were associated with the first LLETZ compared with the second LLETZ biopsy, 76.5% and 69.1% versus 39.5% and 30.9%, respectively. A significantly greater proportion of women in the control group were referred with low-grade cytology (28.0%) and were diagnosed with human papillomavirus/low-grade CIN on histology (31.7%) compared with the first cytologic and LLETZ results in the index group, 9.9% and 8.6%, respectively. Complications were low in both groups; the immediate complication rate was 4% after the first LLETZ compared with 1% after the second LLETZ.
  
  
  CONCLUSIONS
  Most second LLETZ biopsies are performed in women with a history of biopsy-proven high-grade CIN and are not associated with an increased risk of immediate complications.
authors.affiliation: Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, UK.
authors.forename: Esther L
authors.initials: EL
authors.lastname: Moss
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Appleyard
authors.forename: Julie M
authors.initials: JM
authors.lastname: Winning
authors.forename: Peter W
authors.initials: PW
authors.lastname: Jones
authors.forename: David M
authors.initials: DM
authors.lastname: Luesley
mesh_terms: D001706:Biopsy / Q000379:methods / Q000592:standards*; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery*; D003127:Colposcopy; D005260:Female; D006801:Humans; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*