title: Does the number of tissue fragments removed from the cervix with excisional treatment for CIN pathology affect the completeness of excision and cytology recurrence at follow-up? An observational cohort study.
abstract: The objective of our study was to determine whether removing multiple pieces of cervical tissue during large loop excision of the transformation zone (LLETZ) reduced the margin positivity of excision and cytology recurrence rates at follow-up. We conducted an observational cohort study and identified 462 women having had a single LLETZ treatment for cervical intraepithelial neoplasia (CIN) over a two-year period. Women with previous cervical treatment, cervical cancer on the excised tissue or missing follow-up data were excluded. Multiple regression analysis showed that removal of cervical tissue in multiple pieces did not offer any benefit in removing more disease and less recurrence rates. When multiple pieces were taken there was a four-fold increased risk for inconclusive excision margins as reported by the histopathologist. Removal of multiple pieces led to significantly more tissue being removed which may expose the patient to an increased risk of preterm delivery in a future pregnancy.
authors.affiliation: a Department of Obstetrics and Gynaecology , Royal Shrewsbury Hospital , Shrewsbury, Shropshire , SY3 8XQ , UK.
authors.forename: D
authors.initials: D
authors.lastname: Papoutsis
authors.affiliation: a Department of Obstetrics and Gynaecology , Royal Shrewsbury Hospital , Shrewsbury, Shropshire , SY3 8XQ , UK.
authors.forename: J
authors.initials: J
authors.lastname: Panikkar
authors.affiliation: a Department of Obstetrics and Gynaecology , Royal Shrewsbury Hospital , Shrewsbury, Shropshire , SY3 8XQ , UK.
authors.forename: A
authors.initials: A
authors.lastname: Gornall
authors.affiliation: b Cytology Department, Royal Shrewsbury Hospital , Shrewsbury, Shropshire , SY3 8XQ , UK.
authors.forename: S
authors.initials: S
authors.lastname: Blundell
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000601:surgery*
keywords: LLETZ; cytology recurrence; positive excision margins; preterm delivery