Comparison of conization and limited excision of the transformation zone (LETZ) in the treatment of squamous intraepithelial lesions (SIL) of the uterine cervix

Objective: To compare the treatment of squamous intraepithelial lesions of the uterine cervix using conization with limited excision of the transformation zone (LETZ). Material and Methods: A retrospective study of 285 women who received surgical treatment for cervical SIL between 2003 and 2006 was carried out. Prior to treatment, all the women underwent cervicovaginal cytology, colposcopy, and HPV testing. The women whose histology showed the presence of high-grade SIL were then divided into two groups for purposes of comparison: those treated by conization, and those treated by LETZ. Results: In group 1 (treatment by conization), 92 women met the selection criteria, and in group 2 (treatment by LETZ) 33 women met the selection criteria. Histology results showed high-grade SIL involvement of the-cone biopsy surgical margins for 22 cases (23.9%) in group 1, and high-grade SIL involvement of the LETZ surgical margins for six cases (18.1%) in group 2. In 13 of the women in group 2, the indication for LETZ was persistent low-grade SIL. Discussion: The percentage of surgical margins involved was similar in the two groups in our study, and comparable to that reported in the literature (16.2 to 26.6%). Our study, like other published studies, thus supports the possibility in certain cases of treating high-grade cervical SIL conservatively with LETZ or minicones. In the 13 women with a diagnosis of persistent low-grade SIL, 11 of whom (84.6%) were infected with a high-risk HPV genotype, LETZ made a diagnosis of occult high-grade SIL. Conclusion: LETZ may be an alternative to conization in young women, and it is advisable in cases of persistent low-grade SIL with high-risk HPV infection.

Conization; LETZ; SIL; Human papillomavirus

[1] Prendiville W., Cullimore J., Norman S.: “Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia”. Br. J. Obstet. Gynaecol., 1989, 96, 1054.

[2] Naumann R.W., Bell M.C., Alvarez R.D., Edwards R.P., Partridge E.E., Helm C.W. et al.: “LLETZ is an acceptable alternative to diagnostic cold-knife conization”. Gynecol. Oncol., 1994, 55, 224.

[3] Jancar N., Rakar S., Poljak M., Fujs K., Kocjan B.J., Vrtacnik-Bokal E.: “Efficiency of three surgical procedures in eliminating high-risk human papillomavirus infection in women with precancerous cervical lesions”. Eur. J. Gynaecol. Oncol., 2006, 27, 239.

[4] Lohe K.J.: “Function-retaining procedures in cervical intraepithelial neoplasia: Analysis of therapeutical results”. In: Grundmann E. (ed.). Cancer of the Uterine Cervix. Cancer Campaign, Vol. 8. Stuttgart: Gustav Fisher Verlag, 1985, 221.

[5] Noller K.L.: “Incident and demographic trends in cervical neoplasia”. Am. J. Obstet. Gynecol., 1996, 175, 1088.

[6] Rodriguez A.C., Burk R., Herrero R., Hildesheim A., Bratti C., Sherman M.E. et al.: “The natural history of human papillomavirus infection and cervical intraepithelial neoplasia, among young women in the Guanacaste cohort shortly after initiation of sexual life”. Sex. Transm. Dis., 2007, 34, 494.

[7] Nygard J.F., Nygard M., Skare G.B., Thoresen S.O.: “Screening histories of women with CIN 2/3 compared with women diagnosed with invasive cervical cancer: a retrospective analysis of the Norwegian Coordinated Cervical Cancer Screening Program”. Cancer Causes Control., 2005, 16, 463.

[8] Massad S.L., Markwell S., Cejtin H.E., Collins Y.: “Risk of highgrade cervical intraepithelial neoplasia among young women with abnormal screening cytology”. J. Low Genit. Tract. Dis., 2005, 9, 225.

[9] González Bosquet E., Muñoz Almagro M., Mora I., Suñol M., Callejo J., Lailla J.M.: “Prevalence of human papilloma virus infection of the uterine cervix in women with abnormal cytology”. Eur. J. Gynaecol. Oncol., 2006, 27, 135.

[10]Shlay J.C., Dunn T., Byers T., Baron A.E., Douglas J.M. Jr.: “Prediction of cervical intraepithelial neoplasia grade 2-3 using risk assessment and human papillomavirus testing in women with atypia on Papanicolaou smears”. Obstet. Gynecol., 2000, 96, 410.

[11] Paraskevaidis E., Koliopoulos G., Malamou-MitsiV., Zikopoulos K., Paschopoulos M., Pappa L. et al.: “Large loop excision of the transformation zone for treating cervical intraepithelial neoplasia: a 12-year experience”. Anticancer Res., 2001, 21, 3097.

[12] de Cabezon R.H., Sala C.V., Gomis S.S., Lliso A.R., Bellvert C.G.: “Evaluation of cervical dysplasia treatment by large loop excision of the transformation zone (LLETZ). Does completeness of excision determine outcome?”. Eur. J. Obstet. Gynecol. Reprod. Biol., 1998, 78, 83.

[13] Mints M., Gaberi V., Andersson S.: “Miniconization procedure with C-LETZ conization electrode for treatment of cervical intraepithelial neoplasia: a Swedish study”. Acta Obstet. Gynecol. Scand., 2006, 85, 218.

[14] Darwish A., Gadallah H.: “One-step management of cervical lesions”. Int. J. Gynecol. Obstet., 1998, 61, 261.