LARGE LOOP EXCISION OF THE TRANSFORMATION ZONE (LLETZ) AS AN ALTERNATIVE TO BOTH LOCAL ABLATIVE AND CONE BIOPSY TREATMENT - A SERIES OF 1000 PATIENTS

One thousand patients, referred to the Oxford Colposcopy Clinic, were treated with either large loop excision of the transformation zone (LL ETZ, 891 cases) or LLETZ cone (109 cases). Forty-five LLETZ cones were performed empirically, 64 under microcolposcopic guidance. Over 98% o f patients were managed as outpatients under local anaesthesia, and 87 % of new patients treated with LLETZ had treatment at their first visi t. Ninety percent of patients had at least cervical intraepithelial ne oplasia grade one (CIN I) and 73% had CIN II or worse. Seventeen cases of invasive or possibly invasive disease were detected, 6 of them uns uspected. The overall rate of complete excision of CIN or worse was 72 %. Follow-up was cytologic with or without colposcopy depending on les ion severity. Ninety-one percent of 967 treated patients were free of dyskaryosis at a mean follow-up of 23 months, with complete excision o f CIN or worse at LLETZ a significant predictive factor. No cases of i nvasive carcinoma have developed following treatment. Major morbidity was uncommon, with 3.8% severe hemorrhage. Stenosis was noted in 3.8% cases, mostly after LLETZ cone. One patient (0.1%) has reduced fertili ty possibly attributable to LLETZ. Questionnaire assessment revealed a very high degree of acceptability of the treatment to patients. LLETZ and LLETZ cone have proved highly acceptable and effective outpatient diagnostic and treatment alternatives to both local ablation and cone biopsy in the Oxford Colposcopy Clinic.