title: LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training.
abstract: OBJECTIVE
  This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome.
  
  
  METHODS
  This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher's exact test was used.
  
  
  RESULTS
  75 % of all specimens were obtained intact. When the LLETZ specimen was intact, 89 % of smear tests were reported as negative, against 86 % when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation.
  
  
  CONCLUSIONS
  Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6 months post treatment. Enhancing the colposcopy training may help improve clinical outcome.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE UK.
authors.forename: Rasiah
authors.initials: R
authors.lastname: Bharathan
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE UK.
authors.forename: Balvinder
authors.initials: B
authors.lastname: Sagoo
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE UK.
authors.forename: Aravind
authors.initials: A
authors.lastname: Subramaniam
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Larsen-Disney
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fish
keywords: Colposcopy training; Cytological outcome; LLETZ; Specimen fragmentation