title: Multiple levels on LLETZ biopsies do not contribute to patient management.
abstract: OBJECTIVE
  Cervical large loop excision of the transformation zone (LLETZ) specimens are performed both to treat and to diagnose or exclude cervical pre-neoplasia. Examination of these specimens forms a significant part of the routine histological work load of the pathologist, yet histological confirmation of squamous intraepithelial lesion (SIL) or completeness of excision, does not alter the treatment of SIL. When the LLETZ procedure is done, the treatment is complete, the dysplasia having been subject to excision as well as diathermy during the procedure.
  
  
  METHODS
  In this study, records of 1139 women who underwent LLETZ treatment for SIL were examined. The grade of SIL present and the margin status were extracted from histology reports and linked to post-LLETZ follow-up cytology and histology, for a period of 2 years.
  
  
  RESULTS
  SIL recurrence in women with high grade (HG-SIL), low grade SIL (LG-SIL) and normal LLETZ biopsy results was not significantly different. There was no significant difference between the recurrence rates of HG-SIL and LG-SIL with SIL at margins compared to SIL clear of margins.
  
  
  CONCLUSIONS
  Pathologists spend significant time examining multiple levels of LLETZ biopsies, grading SIL, determining margins and trying to find SIL in 'normal' LLETZ biopsies. None of this affects the subsequent follow-up. The most useful data the pathologist can provide is whether invasion is present or not. Pathological effort should be directed to examining multiple levels of those with HG-SIL to find invasion, rather than spending time looking at multiple levels of normal or LG-SIL LLETZ biopsies.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand. diane.kenwright@otago.ac.nz
authors.forename: Diane
authors.initials: D
authors.lastname: Kenwright
authors.forename: Greer
authors.initials: G
authors.lastname: Braam
authors.forename: Dushyant
authors.initials: D
authors.lastname: Maharaj
authors.forename: Fali
authors.initials: F
authors.lastname: Langdana
mesh_terms: D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D009364:Neoplasm Recurrence, Local; D010340:Pathology, Surgical / Q000379:methods*; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000601:surgery*