title: Small lesion size measured by colposcopy may predict absence of cervical intraepithelial neoplasia in a large loop excision of the transformation zone specimen.
abstract: OBJECTIVE
  To evaluate whether colposcopic measurement of the lesion size at diagnosis and/or human papillomavirus (HPV) genotyping can predict the absence of dysplasia in a large loop excision of the transformation zone (LLETZ) specimen in women treated for squamous intraepithelial lesions/cervical intraepithelial neoplasia (SIL/CIN).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  A cohort of 116 women who underwent LLETZ because of biopsy-proven low-grade SIL/CIN that had persisted for 2 years, or because of a high-grade SIL/CIN diagnosed in the referral visit and squamocolumnar junction completely visible (types 1 or 2, according to the International Federation of Cervical Pathology and Colposcopy, IFCPC).
  
  
  METHODS
  After LLETZ the women were classified by histology into the study group (absence of SIL/CIN in the surgical specimen, 28/116, 24.1%) and the control group (SIL/CIN in the LLETZ specimen, 88/116, 75.9%).
  
  
  METHODS
  The size of the lesion determined in the diagnostic colposcopy and the HPV genotype were evaluated in all women.
  
  
  RESULTS
  The lesion size was significantly smaller in the study group (25.7 ± 37.8 versus 84.5 ± 81.7 mm2; P < 0.001). A lesion size of ≤12 mm2and HPV types other than 16 or 18 were associated with an absence of SIL/CIN in the LLETZ specimen (P < 0.001 and P = 0.016, respectively). On multivariate analysis only a lesion size of ≤12 mm2predicted the absence of SIL/CIN (odds ratio, OR 10.6; 95% confidence interval, 95% CI 3.6-30.6; P < 0.001). A lesion size of ≤12 mm2had a specificity of 90.9% (95% CI 83.0-95.3%) and a negative predictive value of 86.0% (95% CI 77.5-91.6%) to predict the absence of SIL/CIN in the surgical specimen.
  
  
  CONCLUSIONS
  Small lesion size in diagnostic colposcopy could predict the absence of SIL/CIN in the LLETZ specimen. Colposcopy measurement of lesion size prior to LLETZ may avoid unnecessary treatment.
  
  
  CONCLUSIONS
  Small lesion size in colposcopic evaluation might predict the absence of SIL/CIN in an LLETZ specimen.
authors: Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: M
authors: M
authors: Munmany
authors: Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona) - Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors: L
authors: L
authors: Marimon
authors: Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: M
authors: M
authors: Cardona
authors: Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: R
authors: R
authors: Nonell
authors: Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: M
authors: M
authors: Juiz
authors: Gynaecological Department, MANSO Primary Assistance Centre, Barcelona, Spain.
authors: R
authors: R
authors: Astudillo
authors: Department of Pathology, CRESIB (Centre de Recerca en Salut Internacional de Barcelona) - Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors: J
authors: J
authors: Ordi
authors: Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: A
authors: A
authors: Torné
authors: Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors: M
authors: M
authors: Del Pino
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D003127:Colposcopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D061809:Human Papillomavirus DNA Tests / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis; D011446:Prospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
keywords: Absence of CIN; HPV; cervical intraepithelial neoplasia; colposcopy; large loop excision of the transformation zone procedure; lesion size