C-LETZ versus large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia: a randomized controlled trial.
OBJECTIVE
To compare large loop excision of the transformation zone (LLETZ) with contour-loop excision of the transformation zone (C-LETZ) in management of cervical intraepithelial neoplasia (CIN) with respect to number of specimens obtained, weight of specimen, surgical margin, treatment time, and morbidity associated with those procedures.


METHODS
Women were randomly allocated to receive LLETZ or C-LETZ. Inclusion criteria were the following circumstances: (1) presence of biopsy-proved CIN 2/3, (2) persistent biopsy-proved CIN 1, (3) discrepancy between cytology and histology, or 4) an endocervical curettage was positive.


RESULTS
Ninety-eight women were eligible for the study. Mean weight of specimens in C-LETZ group was significantly more than LLETZ group (4.35 ± 1.39 vs. 3.55 ± 1.48 g, p = 0.007). Duration of treatment were similar in both groups (p = 0.39). After multiple logistic regressions were analyzed, C-LETZ was more likely to result in a single pathologic specimen (76 vs. 29.16 %, p < 0.001; adjusted RR 8.33, CI 3.23-21.47). There was no statistical significant difference in the frequency of positive margins between the groups (40 vs. 39.5 %, p = 0.64; adjusted RR 1.27, CI 0.46-3.50). The morbidity associated with those procedures was not different between the two groups.


CONCLUSIONS
C-LETZ has a clear clinical benefit in term of a higher rate of a single pathologic specimen. It removes more cervical tissue than LLETZ. The incidence of incomplete excision and complication seem to be similar in both groups.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, 2 Phayathai Road, Rajathevee, Bangkok 10400, Thailand. sathone_b@yahoo.com
Sathone
S
Boonlikit
Siriporn
S
Thitisagulwong
D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D003127:Colposcopy; D019092:Conization / Q000009:adverse effects / Q000379:methods*; D004598:Electrosurgery / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery*