Direct colposcopic vision used with the LLETZ procedure for optimal treatment of CIN: results of joint cohort studies.

ABSTRACT

PURPOSE: To assess the value of direct colposcopic vision (DCV) for optimizing large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN). METHODS: Data from 648 patients who underwent excisional procedures for CIN and were included in two previously published cohort studies were retrospectively reviewed. Women who had a LLETZ were included for analysis (n = 436). Margin status, surgical specimen dimensions and volume were analysed according to the use of colposcopy during procedure. RESULTS: Compared to LLETZ guided by previous colposcopy report only, and to LLETZ performed immediately after colposcopy, DCV allowed for a significantly higher rate of clear margins 33 (52.4 %), 104 (68.0 %) and 142 (84.5 %), respectively (p < 0.001). It also allowed for a significantly higher probability of achieving both negative margins and depth of specimen <10 mm 10 (15.9 %) cases, 47 (30.7 %) cases and 125 (74.4 %) cases, respectively (p < 0.001). In multivariate analysis, when compared with the use of previous colposcopy report or with colposcopy immediately before the LLETZ, DCV allowed for a significantly higher probability of negative margins (AOR 4.61; 95 % CI 2.37-8.99 and AOR 2.55; 95 % CI 1.47-4.41), combined negative margins and depth <75th percentile (AOR 3.67; 95 % CI 1.97-6.86 and AOR 3.05; 95 % CI 1.91-4.87) and combined negative margins and volume <75th percentile (AOR 12.96; 95 % CI 5.99-28.05 and AOR 6.16; 95 % CI 3.75-10.14), respectively. CONCLUSIONS: When used with the LLETZ procedure, DCV allows for optimal outcomes in terms of negative resection margins, and minimized depth and volume of the excised specimen; and should therefore be recommended.