Value and feasibility of LLETZ procedures for pregnant women with suspected high-grade squamous intraepithelial lesions and microinvasive cervical cancer.
OBJECTIVE
To evaluate the efficacy, safety, and feasibility of large loop excision of the transformation zone (LLETZ) procedures during pregnancy.


METHODS
A retrospective study included 27 patients who underwent LLETZ during pregnancy for suspected high-grade squamous intraepithelial lesions (HSIL) where microinvasion could not be excluded. The study investigated intraoperative and postoperative complications, and compared preoperative and postoperative results. Questionnaires were used to obtain information about peripartum and postpartum data.


RESULTS
Three (11.1%) women had invasive or microinvasive cancer, 22 (81.5%) had cervical intraepithelial neoplasia (CIN) 3, and 1 (3.7%) had CIN 2. Twenty-four were positive for high-risk human papillomavirus. All cervical cancers were classified as HSIL or CIN 3 before LLETZ. There were positive resection margins in 15 (55.6%) cases. No intraoperative complications occurred. One (3.7%) patient had a postoperative missed abortion. Major complications such as premature labor or cervical incompetence without influence on delivery occurred after LLETZ in 4 (14.8%) patients.


CONCLUSIONS
LLETZ during pregnancy can be performed if invasive cancer cannot be excluded by colposcopy, cytology, or biopsy. The procedure has a diagnostic intention but can also be a curative therapy in pregnancy, with low intraoperative, postoperative, and peripartum complication rates.
Department of Gynecology and Obstetrics, University of Heidelberg Medical School, Heidelberg, Germany.
Kristina
K
Schaefer
Dorothee
D
Peters
Sebastian
S
Aulmann
Christof
C
Sohn
Michael H R
MH
Eichbaum
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004598:Electrosurgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000601:surgery*