Efficacy and safety of large-loop excision of the transformation zone

Bigrigg, Alison; Haffenden, D. K.; Read, M. D.; Codling, B. W.; Sheehan, A. L.

doi:10.1016/s0140-6736(94)90881-8

Cited by 143 publications

(55 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A specific treatment has been recommended for CIN, that is the application of the LLETZ (Large Loop Excision of Transformation Zone), derived from the Loop Electrode Excision procedure (LEEP) and associated with greater safety and efficacy (95% cure rate in a year) and minor recurrence rates than other surgical procedures [135,140]. Other potentially malignant lesions of anogenital area (AIN, VaIN, VuIN, PIN) represent challenging clinical problems because there are no standard surgical recommendations as for CIN lesions [141].…”

Section: Management Of Genital Hpv Infectionmentioning

confidence: 99%

Oral HPV Infection: Current Strategies for Prevention and Therapy

Syrjänen

Termine

Capra³

et al. 2012

CPD

View full text Add to dashboard Cite

Infection with High Risk (HR) Human Papillomaviruses (HPVs) is the main aetiological agent of Cervical Squamous Cell Carcinoma (CSCC) and also associated in a subgroup of other neoplasms, including Oropharyngeal Squamous cell Carcinoma (OPSCC). HPV infection, in genital as in oral mucosa, can also be subclinical or associated with benign proliferative lesions (common warts, condylomas, papillomas) caused mostly by infection with Low Risk (LR)-HPVs. In the last decades, extensive research has resulted in growing knowledge on HPV biology and specifically viral life cycle, biochemical properties of viral proteins and their interaction with the host proteins leading to potential new targets of prophylactic or therapeutic vaccines and therapies for HPV infection. In addition, notable progresses have been made in the field of diagnostics to detect HPV DNA or RNA. The recent epidemiological data suggest the significant changes in HPV endemic, due to the changes in sexual habits especially among young generations (i.e. early sexual debuts, multiple sexual partners, oral and anal sex); this scenario has urged on the need of adequate campaigns of primary (sexual education, vaccination programs) and secondary prevention (diagnostics of HPV-related diseases). Due to the growing interest on HPV infection and HPV related cancers, the authors made a narrative review of the literature on oral HPV infection and oral-genital transmission. After this, in view of the controversies about the strategies of therapy and prevention of HPV infection, the present review focuses on the current state of art about the available tools for the therapeutic and, if any, preventive management of oral HPV infection.

show abstract

Section: Management Of Genital Hpv Infectionmentioning

confidence: 99%

Oral HPV Infection: Current Strategies for Prevention and Therapy

Syrjänen

Termine

Capra³

et al. 2012

CPD

View full text Add to dashboard Cite

show abstract

“…47,48 Unlike cervical dysplasia, where a large loop excision of the transformation zone has 95% one-year cure rates in HIV-positive women, no evidence for such efficacy with simple procedural intervention is provided for the anal canal. 49 The anal canal is also structurally more difficult to negotiate than the cervix and excision of the entire transformation zone would not be possible. There are no documented benefits in favour of anal Pap smear screening to date and large population-based randomized controlled trials are needed to examine the survival benefit in anal Pap smear versus no screening test.…”

Section: Obstacles To Screeningmentioning

confidence: 99%

Perianal Condylomas, Anal Squamous Intraepithelial Neoplasms and Screening: A Review of the Literature

Oon

Winter

2010

J Med Screen

View full text Add to dashboard Cite

Anal squamous intraepithelial lesions (ASILs) are the precursors to anal cancer. Human papillomavirus infection has a direct link to ASIL formation and is responsible for up to 80% of anal cancers. But while much importance has been focused on targeting cancer precursors in the cervix, relatively little concern has been afforded to the anal canal. With the advent of cervical Pap smear screening in various regions, the incidence of cervical cancer has declined. However, marked similarities in the biological and pathological profiles of cervical cancer and anal cancer mean that anal cancer should be preventable in the same way – by curbing the progression of ASIL to cancer. This article explores the literature on ASILs and the growing problem of anal cancer in the community, along with the literature surrounding the current progress towards implementing a screening programme for ASIL in the future.

show abstract

“…This has been confirmed in several retrospective and observational studies. 2,8,13,[17][18][19][20][21][22] This selection results in diagnostic procedures being performed only in those patients who have the necessary risk factor present for the development of recurrent/residual CIN lesions and avoids unnecessary diagnostic procedures in patients without this risk factor. Consequently, this policy can lead to an important reduction in health costs and anxiety.…”

mentioning

confidence: 99%

Post‐treatment CIN: Randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease

Bais

Eijkemans

Snijders

et al. 2008

Intl Journal of Cancer

View full text Add to dashboard Cite

We investigated in a randomised clinical trial whether addition of hrHPV testing (high-risk human papillomavirus) to cytological follow-up after treatment for high-grade CIN (cervical intraepithelial neoplasia 2/3) can lead to a better selection of women at risk for residual/recurrent CIN. We included 210 women with high-grade CIN undergoing treatment in outpatient clinics in The Netherlands. Follow-up was based on cytology alone and cytology combined with hrHPV detection. Our primary outcome measurement was improving specificity for residual/recurrent CIN after treatment. Secondary, we compared health-care costs and impact of individual hrHPV type on the risk of residual/recurrent CIN. Follow-up by abnormal cytology alone (6, 12 and 24 months after treatment according to the Dutch protocol) showed a lower specificity for detection of residual/recurrent CIN than follow-up by abnormal cytology and presence of hrHPV (80 vs. 91%, relative risk 0.87 (95% CI 0.77-0.99)). Both methods showed no significant difference in sensitivity ((86 vs. 100%) RR 0.86 (95% CI 0.63-1.16)). Comparing different post hoc modifications in the strategy of combined testing showed similar test characteristics when lowrisk women (normal cytology and hrHPV negative at 6 months) omitted the 12 months visit (specificity 91%, p 5 1.00 z 5 0.00). Prediction of residual/recurrent CIN by typing of hrHPV could not be confirmed. Total health-care costs using cytology and hrHPV testing during follow-up decreased when low-risk women omit the 12 months visit. Follow-up after treatment for high-grade CIN can be improved by combining cytology with hrHPV testing. We advise combined cytology and hrHPV testing at 6, 12 and 24 months after treatment. Low-risk women may omit the 12 months visit, resulting in cost reduction. ' 2008 Wiley-Liss, Inc.Key words: cervical intraepithelial neoplasia; human papillomavirus; residual/recurrent CIN; RCT According to current Dutch standards, follow-up after treatment for high-grade CIN (cervical intraepithelial neoplasia 2/3) consists of cervical cytological monitoring at 6, 12 and 24 months, to identify residual/recurrent CIN lesions (CIN 2/3).1 Colposcopic examination is performed where there is abnormal cervical cytology. In case of normal cytology after 24 months, follow-up will be performed within the national screening program. One of the drawbacks of cervical cytological follow-up after treatment is the high number of false-positive findings. Approximately 20% of the women have abnormal cervical cytology within the first 2 years of follow-up. However, in more than half of these women no underlying residual/recurrent CIN will be found, resulting in unnecessary diagnostic and therapeutic procedures.2-6 The reported residual/recurrent high-grade CIN rates vary between 5 and 35%. 2,3,[7][8][9] A persistent infection with high-risk human papillomavirus (hrHPV) is necessary for the development, maintenance and progression of primary CIN lesions. [10][11][12] It is assumed that effective treatment for CIN lesions results...

show abstract

Efficacy and safety of large-loop excision of the transformation zone

Cited by 143 publications

References 6 publications

Oral HPV Infection: Current Strategies for Prevention and Therapy

Oral HPV Infection: Current Strategies for Prevention and Therapy

Perianal Condylomas, Anal Squamous Intraepithelial Neoplasms and Screening: A Review of the Literature

Post‐treatment CIN: Randomised clinical trial using hrHPV testing for prediction of residual/recurrent disease

Contact Info

Product

Resources

About