THE USE OF LARGE LOOP EXCISION OF THE TRANSFORMATION ZONE IN MANAGEMENT PROBLEMS OF CERVICAL INTRAEPITHELIAL NEOPLASIA

We studied 2 groups of women whose management is controversial: those with cervical intraepithelial neoplasia (CIN) grade 2 or 3 on smear, b ut only CIN grade 1 or no abnormality on target biopsy (Group I), and those with persistent CIN grade 1 on smear and up to CIN 1 on biopsy ( Group 2). We set out to assess whether large loop excision of the tran sformation zone (LLETZ) was an acceptable method of treating these 2 g roups of women. A review of 100 consecutive patients was undertaken. T here were 71 women in Group 1 and 29 women in Group 2. The LLETZ proce dures were performed under local analgesia and no immediate problems w ere encountered. Delayed haemorrhage requiring vaginal packing and adm ission to hospital occurred in 1 patient. In Group 1, histopathology o f the LLETZ biopsies showed CIN 2 or 3 in 29 (40.8%) of the women, CIN 1 in 24 (33.8%) and no CIN in 18 (25.3%), and in Group 2, CIN 2 or 3 was seen in 5 (17.2%) of the women, CIN I in 11 (37.9%) and no CIN in 13 (44.8%). At 12 months completed follow-up, 4 patients in Group 1 ha d recurrent CLN 1 or equivocal CIN 1 and 1 patient from Group 2 had re current CIN 1, giving an overall recurrence rate of 5 of the 94 patien ts who completed follow-up (5%). We concluded that LLETZ was a useful procedure in both groups. In Group 1 the provision of a histological d iagnosis on the LLETZ biopsy was a check on the accuracy of the cervic al smear report. In Group 2, LLETZ offered the advantage of rapidly re turning the smear to normal in most patients, and the diagnosis and tr eatment of those women who actually had a high-grade lesion.