title: Benefits of Direct Colposcopic Vision for Optimal LLETZ Procedure: A Prospective Multicenter Study.
abstract: OBJECTIVE
  The aim of the study was to assess whether direct colposcopic vision (DCV) of the cervix during large loop excision of the transformation zone (LLETZ) is associated with a decrease in the volume and dimensions of specimens or affects margin status at histology.
  
  
  METHODS
  A prospective multicenter observational study of 216 women who underwent LLETZ for grades 2 and 3 cervical intraepithelial neoplasia was conducted. The volume and dimensions (circumference, length, and thickness) of the surgical specimens were measured before fixation. Data were compared according to the use of colposcopy during LLETZ. The following 3 groups were considered: LLETZ performed without colposcopy (n = 91), LLETZ performed immediately after colposcopy (n = 51), and LLETZ performed under DCV (n = 74).
  
  
  RESULTS
  Patient characteristics were comparable with regard to age, parity, history of excision, indication of the procedure, and the size of the cervix. We found a significant decrease in all dimensions of the specimens obtained under DCV (p < .001). Margin status was not affected. After adjusting for confounders, the mean volumes were significantly lower in the DCV group (adjusted mean difference = -0.66 mL; 95% CI = -1.17 to -0.14). The probability that negative margins would be achieved together with the attainment of a volume less than 5 mL and a thickness less than 10 mm was the highest in the DCV group (adjusted OR = 2.80; 95% CI = 1.13 to 6.90).
  
  
  CONCLUSIONS
  Direct colposcopic vision is associated with a significant decrease in the volume and in all dimensions of LLETZ specimens with no compromise in the margin status.
authors.affiliation: 1Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, CNRS, IRD, Avignon Université, Marseille; 2University Hospital of Amiens, Jules Verne University, Picardie; 3Aix Marseille Université, Inserm, IRD, UMR S912, SESSTIM; 4Public Health Department, APHM, Hôpital de la Timone, BioSTIC, Marseille; 5Department of Obstetrics and Gynaecology, Femme Mère Enfant University Hospital, Lyon-Bron; 6Teaching hospital of Rennes, Gynaecologic Department, University of Rennes 1, Rennes;7Department of Obstetrics and Gynaecology, Hospital of Hautepierre, Strasbourg University Hospitals, Strasbourg; 8Department of Pathology, CHU Pontchaillou, Rennes; 9Department of Pathology, HôpitalNord, Assistance Publique des Hôpitaux de Marseille, Marseille 10Department of Obstetrics and Gynaecology, Hopital La Conception, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Marseille; 11Department of Gynaecologic and Oncologic Surgery, CHU Dijon, Dijon; 12Pôle Mère-Femme, University Hospital Jean Minjoz, Besançon; and 13Pôle d'Obstétrique Reproduction Gynécologie, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, Bordeaux, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Preaubert
authors.forename: Jean
authors.initials: J
authors.lastname: Gondry
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Julien
authors.initials: J
authors.lastname: Chevreau
authors.forename: Gery
authors.initials: G
authors.lastname: Lamblin
authors.forename: Anthony
authors.initials: A
authors.lastname: Atallah
authors.forename: Vincent
authors.initials: V
authors.lastname: Lavoue
authors.forename: Claire
authors.initials: C
authors.lastname: Caradec
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Baldauf
authors.forename: Angélique
authors.initials: A
authors.lastname: Bryand
authors.forename: Sebastien
authors.initials: S
authors.lastname: Henno
authors.forename: Julia
authors.initials: J
authors.lastname: Villeret
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
authors.forename: Serge
authors.initials: S
authors.lastname: Douvier
authors.forename: Adelaide
authors.initials: A
authors.lastname: Jarniat
authors.forename: Didier
authors.initials: D
authors.lastname: Riethmuller
authors.forename: Anne
authors.initials: A
authors.lastname: Mendel
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Brun
authors.forename: Hajanarina
authors.initials: H
authors.lastname: Rakotomahenina
authors.forename: Xavier
authors.initials: X
authors.lastname: Carcopino
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D011446:Prospective Studies; D016896:Treatment Outcome; D002578:Uterine Cervical Dysplasia / Q000601:surgery*