The Use of Large Loop Excision of the Transformation Zone (LLETZ) in an Outpatient Setting

Powell, Beverley

doi:10.1111/j.1479-828x.1996.tb02725.x

Cited by 11 publications

(12 citation statements)

References 46 publications

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“…Three out of four of the prospective studies with immediate excision biopsies were at the upper end of the specificity spectrum 67.5–79.4%, but showed lower sensitivity (55.9–82.8%) 8,35,53 . Four studies reported specificities of <5% but sensitivities between 87.4 and 99.2% 34,36,39,40 …”

Section: Resultsmentioning

confidence: 94%

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Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Underwood

Arbyn

Smith

et al. 2012

BJOG

103

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Background The colposcopy-directed punch biopsy is widely used in the management of women with abnormal cervical cytology; however, its accuracy compared with definitive histology from an excision biopsy is not well established.Objectives To assess the accuracy of the colposcopy-directed punch biopsy to diagnose high-grade cervical intraepithelial neoplasia (CIN) by performing a systematic review and meta-analysis.Search strategy A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed.Selection criteria Articles that compared the colposcopically directed cervical punch biopsy with definitive histology from an excisional cervical biopsy or hysterectomy.Data collection and analysis Random effects and hierarchical summary receiver operating characteristic regression models were used to compute the pooled sensitivity and specificity applying different test cut-offs for outcomes of high-grade CIN.Main results Thirty-two papers comprising 7873 paired punch/ definitive histology results were identified. The pooled sensitivity for a punch biopsy defined as test cut-off CIN1+ to diagnose CIN2+ disease was 91.3% (95% CI 85.3-94.9%) and the specificity was 24.6% (95% CI 16.0-35.9%). In most of the studies, the majority of enrolled women had positive punch biopsies. Pooling of the four studies where the excision biopsy was performed immediately after the punch biopsy, and where the rate of positive punch biopsies was considerably lower, yielded a sensitivity of 81.4% and specificity of 63.3%.Author's conclusion The observed high sensitivity of the punch biopsy derived from all studies is probably the result of verification bias.

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Section: Resultsmentioning

confidence: 94%

“…8,35,53 Four studies reported specificities of <5% but sensitivities between 87.4 and 99.2%. 34,36,39,40 When using the disease threshold of CIN3+, the sensitivity was similar (91.1%; 95% CI 83.7-95.4%) but a substantially lower specificity was noted (18.2%; 95% CI 11.3-27.9%) ( Figure 2).…”

Section: Accuracy Of Punch Biopsiesmentioning

confidence: 97%

Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Underwood

Arbyn

Smith

et al. 2012

BJOG

103

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“…Powell (1996) 8 believes that this policy could potentially lead to reduced costs to patients in terms of time and money, resulting in better compliance with treatment and follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

et al. 2009

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Efetividade da abordagem "ver e tratar" em lesões pré-invasivas no colo uterino ABSTRACT OBJECTIVE: To compare the effectiveness between the see-and-treat (S&T) approach and the conventional one (with prior biopsy) for squamous intraepithelial lesions of uterine cervix. METhODS:A cross-sectional study was conducted with 900 nonpregnant women with cytology suggestive of high grade squamous intraepithelial lesions in the city of Rio de Janeiro, Southeastern Brazil, between 1998 and 2004. The S&T approach consists of a large loop excision of the transformation zone procedure and is recommended when cytology is suggestive of high grade squamous intraepithelial lesion, satisfactory colposcopy with abnormalities compatible with the suspected cytological results, and the lesion is limited to the ectocervix or extends up to one centimeter of the endocervical canal. A subgroup of 336 patients whose colposcopy was considered satisfactory was analyzed, and they were divided into two groups for comparison: patients treated without prior biopsy (n = 288) and patients treated after a biopsy showing high grade squamous intraepithelial lesions (n = 48). Patients who were not treated or only treated more than a year later after recruitment at the colposcopy unit were considered dropouts. RESULTS:Of patients recruited during the study period, 71 were not treated or were only treated for at least a year. The overall dropout rate was 7.9% (95% CI: 6.1;9.7). Mean time elapsed between patient recruitment and treatment was 17.5 days in the S&T group and 102.5 days in the prior biopsy group. Dropout rates were 1.4% (95% CI: 0.04;2.7) and 5.% (95% CI: 0;12.3), respectively (p=0.07). The proportion of overtreated cases (negative histology) in the S&T group was 2.0% (95% CI: 0.4;3.6). CONCLUSIONS:The difference in the mean time elapsed between patient recruitment and treatment indicates that S&T is a time-saving approach The proportion of negative cases from using the S&T approach can be regarded as low. The "see-and-treat" (S&T) approach for high-grade intraepithelial squamous lesions (HSIL) of uterine cervix consists of performing both diagnosis and treatment in one single visit. In Brazil, this approach was launched in 1997 as part of the National Program a for Uterine Cancer Management, Viva Mulher, to treat pre-invasive cervical lesions. The S&T approach included a large loop excision of the transformation zone (LLETZ) 9 procedure and is recommended when cytology is suggestive of HSIL (or cervical intraepithelial neoplasia grades 2 or 3 -CIN 2/3), satisfactory colposcopy (transformation zone completely visible) with abnormalities compatible with the suspected cytological results, and the lesion is limited to the ectocervix or extends up to one centimeter of the endocervical RESUMO OBJETIVO: Comparar a efetividade do método "ver-e-tratar" (V&T) com a abordagem tradicional (biópsia prévia) das lesões escamosas intraepiteliais do colo uterino. DESCRIPTORS:MéTODOS: Trata-se de um estudo transversal realizado na cidade do Rio de Janeiro, ...

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“…Lesion outside the range of colposcopic assessment. 2. Cytology and colposcopy findings differ significantly.…”

Section: Cin 2 or 3 On Colposcopyhistologjmentioning

confidence: 97%

“…The ease with which the procedure can be performed with local analgesia has resulted in a 'see and treat' approach to the management of Pap smear abnormalities in some centres, without waiting for histological confirmation of CIN. Emphasis should be placed on the proper indications for LLETZ cone biopsy, as a 'see and treat' approach has the potential to overtreat many young women, and cannot be advocated (2,3).…”

Section: Large Loop Excision Qf the Transformation Zone (Lletz)mentioning

confidence: 99%

Management of the Abnormal Cervical Smear and a Historical Review of Cone Biopsy in Victoria

Allen

Beischer

1998

Aust NZ J Obst Gynaeco

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The Use of Large Loop Excision of the Transformation Zone (LLETZ) in an Outpatient Setting

Cited by 11 publications

References 46 publications

Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

Management of the Abnormal Cervical Smear and a Historical Review of Cone Biopsy in Victoria

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