Artifact in cervical LLETZ specimens: Correlation with follow-up

The effect of cautery artifact on the ability to accurately diagnose dyspla sia and predict abnormal follow-up in large loop excision specimens of the transformation zone (LLETZ) has not been adequately addressed in the pathol ogy literature. One hundred consecutive conization specimens with cytologic and/or histologic follow-up were studied. Indications for the procedure we re high-grade squamous intraepithelial lesion (on Pap smear and/or biopsy) in 64 cases, low-grade squamous intraepithelial lesion in 28? atypical squa mous cells of unknown significance (ASCUS) in 3, atypical glandular cells o f unknown significance in 2, adenocarcinoma in situ, squamous carcinoma in situ, and invasive squamous carcinoma in 1 each. Twenty-four specimens were cold-knife conizations (CKCs) and 76 LLETZs. All LLETZs had at least 1+ ar tifact, and in 46 cases (61%) it interfered with at least one aspect of eva luation. In 21 cases (28%), 1+ artifact interfered only with margin assessm ent. In 25 cases (33%), there was 2+ or 3+ artifact precluding not only mar gin assessment, but also diagnosis and grading of dysplasia. Of the 43 LLET Zs received in more than one piece, 33 (77%) had interfering artifact, and in 21 (49%) it was 2+ or 3+, at least focally interfering with diagnosis an d grading. In contrast, of 33 LLETZs received in a single piece, only 13 (3 9%) had interfering artifact, which was 2+ or 3+ in 4 (12%), (p < 0.05). Po sitive follow-up (including ASCUS, favor dysplasia, and ASCUS, not otherwis e specified) was found in 6 of 7 CKCs with positive margins (86%), 10 of 16 LLETZs with positive margins (63%), and 4 of 7 LLETZs with unassessable ma rgins (57%). In cases with negative cone margins, positive follow-up was fo und in 2 of 17 CKCs (12%), and 18 of 53 LLETZs (34%), p < 0.05; a higher fr equency of interfering artifact (p<0.05) was seen in these cases. LLETZ mar gin status and postprocedure endocervical curettage (ECC) specimens were no t good predictors of residual disease, unlike margin status in CKC. Post-CK C ECC was a better predictor of subsequent abnormal follow-up than post-LLE TZ ECC (p < 0.05). The presence of interfering artifact was only rarely men tioned in the original pathology report. In conclusion, the status of margi ns is a better predictor of abnormal follow-up in CKC than in LLETZ specime ns. Fragmentation of the specimen is an additional factor, compounding the inevitable artifact. Postprocedure ECC is not a useful indicator of residua l dysplasia. The pathologist should not hesitate to comment on specimen ade quacy in surgical pathology reports.