Therapeutic Effectiveness of Large Loop Excision of Transformation Zone (LLETZ) in Management of Cervical Lesions

Salvi, Anuradha; Gupta, Shilpi Singh; Agarwal, Pratibha; Gupta, Divender; Rajoria, Lata; Verma, Asha

doi:10.7439/ijbar.v7i1.2787

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…23 but other studies reported lower rate (20%) and (10%) respectively. 21,22 1 case (12.5%) with NILM in our study had CIN 2 on HPE, similarly reported by another study (10.6%). 21 Another studies reported lower percentage (3.4%) and (4%).…”

Section: Discussionsupporting

confidence: 90%

“…One study reported incidence of CIN 1 and CIN 2,3 in 11.25% and 10% respectively and sensitivity of colposcopy was 83.33%. 9 In our study chronic cervicitis was found in 36.4%, CIN [21][22][23] 50% women with HSIL in our study had squamous cell carcinoma (SCC) cervix on HPE, near to findings reported in one study (41.67%). 23 but other studies reported lower rate (20%) and (10%) respectively.…”

Section: Discussionsupporting

confidence: 69%

“…21 Another studies reported lower percentage (3.4%) and (4%). 22,23 This difference can be attributed to smaller sample size of our NILM group. 14.3% patient with reactive cellular changes had SCC on HPE, almost similar to finding of another study (11.1%).…”

Section: Discussionmentioning

confidence: 89%

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Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

Sachan¹,

Shukla²,

Sachan³

et al. 2020

IJMEDPH

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Background: Evidence for using colposcopy in the absence of a squamous intraepithelial lesion on conventional cytology has important position in cervical cancer screening. Aim of this study to evaluate sensitivity, specificity and diagnostic accuracy of colposcopy and cytology in unhealthy cervix to know role of colposcopy in concurrent use with cytology or replacing to cytology at tertiary centre experience. Methods: Prospective study was carried out over a period of one year, in patients attending Gynaecology OPD, King George's Medical University, Lucknow, Uttar Pradesh. After informed consent and ethical clearance from institutional ethics committee, total 664 diagnostic colposcopy were performed in women presenting with gynaecological complaint. These women were called for concurrent colposcopy and pap smear. 41 women were lost to follow up, only 623 women were subjected for concurrent colposcopy and cytology. 99 women who had high grade colposcopy with Swede score ≥5 underwent colposcopic guided biopsy and tissue were sent for histopathological examination and cytology of same patients were compared for analysis. Results: Mean age of women was 42.68±11.69 years and mean age of consummation of marriage 20.94±3.21years. Cervical erosion was most common finding (41.4%) followed by hypertrophy of cervix (33.3%) and cervix bleeds on touch (17.2%). 24.14% (n=7) women with ASCUS cytology had high grade HPE (CIN2 +) while 42.3% (n=11) women with LSIL had high grade HPE (CIN2 +). Taking ASCUS and above as cutoff , the sensitivity, specificity, of Pap smear was 97.8%, 14.6% and diagnostic accuracy was 55.3%. For overall analysis of Colposcopy Swede Score at ≥5, colposcopy was 100% sensitive and 41.2% specific and diagnostic accuracy was 69.7%. At swede score ≥7, colposcopy was 64.6% sensitive and 100% specific and diagnostic accuracy was 82.8%. Conclusion: Colposcopy has good sensitivity and specificity as compared to cytology and can be used in evaluation of abnormal or controversial cytology to obtain better outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 69%

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Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

Sachan¹,

Shukla²,

Sachan³

et al. 2020

IJMEDPH

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Patient and provider perspectives on LEEP/LLETZ treatment and outcomes: an interview study

Giovannetti

Tomalty

Greco

et al. 2023

The Journal of Sexual Medicine

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Background The loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone (LLETZ) effectively treat cervical dysplasia, though some women have reported negative outcomes postoperatively (e.g., sexual dysfunction, psychosexual sequalae). There is insufficient understanding of patient experiences with these symptoms and perspectives from the providers who perform LEEP/LLETZ. Aim To characterize the perceptions and experiences of LEEP/LLETZ treatment from providers and patients, including whether there is a characteristic symptom profile of women who report negative outcomes. Methods Patients who had LEEP/LLETZ treatment and reported negative outcomes and providers who perform LEEP/LLETZ completed semistructured interviews about their perceptions and experiences, which were coded through thematic analysis (NVivo 12; QSR International). Patients also completed an online survey assessing demographics, medical history, and sexual function. Outcomes Outcomes included perspectives generated from patient and provider interviews regarding LEEP/LLETZ procedural outcomes, including symptoms and experiences related to sexual functioning. Results Perspectives and experiences gathered from patient and provider interviews revealed misaligned narratives surrounding LEEP/LLETZ outcomes and treatment. We identified 4 overarching themes encapsulating provider and patient responses: Expectations for Preoperative Consultation; Procedure Experiences; Attitudes; and Resources. Patients reported a unique symptom profile and negative outcome experiences, namely surrounding domains of sexual functioning: decreased physical sensations, orgasm response, and vaginal discharge, as well as loss of arousal, interest, and desire. Patients described changes to overall quality of life, with impacts to interpersonal relationships. Patients discussed preferring open-ended and directed questions to comprehensively elucidate negative outcomes. Provider narratives outlined the current process of care, emphasizing limited experiences with adverse outcomes (e.g., sexual issues) and the use of open-ended questions during counseling. Providers described an evolving intention to create comfortable clinical spaces. Regarding pre- and postoperative resources, patients described seeking support from online patient groups, and providers disclosed limitations to providing resources. Clinical Implications Evidence of discordance between patient and provider perspectives of LEEP/LLETZ reveals a need to reassess clinical practices surrounding this procedure at the level of discussions regarding informed consent, sexual function, and available resources. Strengths and Limitations This study is the first to examine patient and provider perspectives on LEEP/LLETZ treatment. Only patients who self-report negative outcomes were recruited, to elicit narratives from this specific subpopulation. Conclusion Results indicate a characteristic symptom profile of women who undergo LEEP/LLETZ and report negative outcomes and that the perceptions of patients and providers differ regarding several aspects of the treatment experience, supporting the need for directed open conversation and comprehensive pre- and postoperative sexual counseling.

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Therapeutic Effectiveness of Large Loop Excision of Transformation Zone (LLETZ) in Management of Cervical Lesions

Cited by 2 publications

References 14 publications

Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

Patient and provider perspectives on LEEP/LLETZ treatment and outcomes: an interview study

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