LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training

• Published in: Journal of obstetrics and gynaecology of India 2013-10, Vol.63 (5), p.332-336
• Main Authors: Bharathan, Rasiah, Sagoo, Balvinder, Subramaniam, Aravind, Larsen-Disney, Peter, Fish, Andrew
• Format: Article
• Language: English
• Subjects: Gynecology; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Original; Original Article
• ISSN: 0971-9202; 0975-6434
• DOI: 10.1007/s13224-012-0332-8

Purpose This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome. Method This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher’s exact test was used. Results 75 % of all specimens were obtained intact. When the LLETZ specimen was intact, 89 % of smear tests were reported as negative, against 86 % when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation. Conclusion Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6 months post treatment. Enhancing the colposcopy training may help improve clinical outcome.