Loop Electrosurgical Excision Procedure for Squamous Intraepithelial Lesions of the Cervix: Advantages and Potential Pitfalls

Ferenczy, Alex; Choukroun, Denis; Arseneau, Jocelyne

doi:10.1016/0029-7844(95)00453-x

Cited by 75 publications

(51 citation statements)

References 16 publications

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“…It is unlikely that the three women with CIN 2/3 who were negative with Amplicor HPV were misclassified, since a second pathologist confirmed the diagnosis (8,13). Several groups compared HC-2 and Amplicor HPV in different clinical settings and reported good levels of agreement for HR HPV DNA detection, from 78% to 89%, and kappa values from 0.61 to 0.78 (4,11,16,17,23,27).…”

Section: Discussionmentioning

confidence: 99%

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

et al. 2011

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Up to 20% of women having a cytology smear showing atypical squamous cells of undetermined significance (ASC-US) and infected with high-risk human papillomavirus (HR HPV) have high-grade cervical intraepithelial neoplasia (CIN 2/3). Results obtained with theHigh-risk human papillomavirus (HR HPV) genotypes are associated with high-grade cervical intraepithelial neoplasia (CIN 2/3) and cancer of the uterine cervix (2, 3). Primary screening of cervical cancer is essentially based on Pap cytology testing. In North America, for each new case of cervical cancer screened by cytology, there are between 50 and 100 cases of abnormal smears consistent with low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL) (9). Additionally, there are at least twice as many cases of equivocal or borderline atypias, referred to as "atypical squamous cells of undetermined significance" (ASC-US). Three options have been proposed by the American Society for Colposcopy and Cervical Pathology to perform triage on women with ASC-US, namely, repeat cytology, immediate referral to colposcopy, and reflex HR HPV testing (28).The most widely used HR HPV detection assay for the triage of women with ASC-US is the Hybrid Capture 2 assay (HC-2; Qiagen, Inc., Mississauga, Ontario, Canada) (15). The HC-2 and Amplicor HPV (Roche Diagnostics, Laval, Quebec, Canada) tests detect the same 13 HR genotypes and are approved by Health Canada for clinical use. Several studies have evaluated the Amplicor HPV test, but only one analyzed fresh samples collected from women with ASC-US (4,11,14,15,25,26,27). The evaluation of the performance of the Amplicor HPV test in a diagnostic setting is mandatory to assess its utility in the management of women with ASC-US. We evaluated the clinical performance of two generic HPV assays, Amplicor HPV and HC-2, on fresh clinical specimens obtained prospectively from women referred to colposcopy because of an ASC-US cytology result. HPV genotypic analysis was performed on all samples to assess the cross-reactivity of the HPV generic assays. MATERIALS AND METHODSStudy design and population. Participants were recruited consecutively if (i) they were referred to colposcopy because of at least one ASC-US cytology, (ii) were Ն24 years old, and (iii) had not received treatment for CIN in the last 2 years. During the study period, HPV DNA testing was not widely available to primary care physicians in the study area and women were referred to colposcopy

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Section: Discussionmentioning

confidence: 99%

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

et al. 2011

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“…One, with no specimen to submit for histologic examination, both laser vaporization and cryotherapy will miss the unsuspected adenocarcinoma in situ and microinvasive squamous cell carcinoma found in 2% to 3% of specimens. 1,2 Two, complications are not necessarily fewer with cryo. Mitchell and colleagues 3 found no differences in rates of complications (or success) when they randomized treatment to 1 of 3 modalities-cryo, laser, or LEEP.…”

Section: Leep In the Family Practice Settingmentioning

confidence: 99%

Response: LEEP in the Family Practice Setting

Nuovo¹

2003

The Journal of the American Board of Family Medicine

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We try to publish authors' responses in the same edition with readers' comments. Time constraints might prevent this in some cases. The problem is compounded in a bimonthly journal where continuity of comment and redress are difficult to achieve. When the redress appears 2 months after the comment, 4 months will have passed since the article was published. Therefore, we would suggest to our readers that their correspondence about published papers be submitted as soon as possible after the article appears.

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“…Die Häufigkeit von intra-und postoperativen Blutungen hängt in erster Linie ebenfalls von der Exzisionshöhe [10] ab und nicht von der Konisationsmethode. Gerät man bei der Exzision in der Tiefe zuweit nach lateral, trifft man auf kleine Arterien, welche intra-und postoperativ gerne bluten.…”

Section: Blutungenunclassified

Laserkonisationen und -vaporisationen der Portio

Kieni

Rageth

2000

Gynäkol Geburtshilfliche Rundsch

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Fragestellung: Analyse der Histologiepräparate und der Krankheitsverläufe nach Lasereingriffen an der Portio. Methode: Von 136 Lasereingriffen (110 Konisationen und 26 Vaporisationen) fanden 103 (76%) ambulant und 122 (89%) unter Lokalanästhesie statt. Ergebnisse: 94 (85%) der 110 Konisationen erfolgten histologisch im Gesunden. Verlauf nach 12 (11%) nicht im Gesunden erfolgten Konisationen: 5mal normale Zytologie, 4mal keine Dysplasie im Hysterektomiepräparat, 1mal CIN III im Hysterektomiepräparat, 1mal CIN I im Wertheim-Präparat und 1mal unbekannt. Verlauf nach 4 fraglich im Gesunden erfolgten Exzisionen: 3mal normale Zytologie und 1mal Hysterektomie ohne Restdysplasie: Acht postoperative Blutungen mussten mit Bikoagulation versorgt werden. Schlussfolgerungen: Die Lasertherapie ermöglicht vor allem ektozervikal ein ausserordentlich präzises Vorgehen, kann meist ambulant und unter Lokalanästhesie durchgeführt werden und führt im Vergleich zu anderen Methoden nicht zu mehr Komplikationen. Erfolgt die Resektion nicht im Gesunden, findet sich im weiteren Verlauf nur selten eine Dysplasiepersistenz. Deshalb ist ein exspektatives Vorgehen bei vorhandenem Kinderwunsch zu verantworten.

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Loop Electrosurgical Excision Procedure for Squamous Intraepithelial Lesions of the Cervix: Advantages and Potential Pitfalls

Cited by 75 publications

References 16 publications

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

Human Papillomavirus (HPV) DNA Triage of Women with Atypical Squamous Cells of Undetermined Significance with Amplicor HPV and Hybrid Capture 2 Assays for Detection of High-Grade Lesions of the Uterine Cervix

Response: LEEP in the Family Practice Setting

Laserkonisationen und -vaporisationen der Portio

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