The 20-year experience with large loop excision of the transformation zone (LLETZ) at Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre ...from Zagreb is presented. This retrospective observational study included 1407 women with cervical dysplasia treated by LLETZ technique during the 1995-2016 period. LLETZ was most commonly performed in the 25-35 age group (51%), followed by the 36-45 age group (22%), and least frequently in the >65 age group (2%). Histopathologic results lower than high-grade squamous intraepithelial lesion were found in 23% and high grade squamous intraepithelial lesion or worse findings in 77% of patients. Positive margin as a sign of possible residual dysplasia was found in 25% of cones, 80% of which included endocervical positive margin. Cervical canal biopsy result was positive in 18% of cases. Accurate colposcopy and its findings can help avoid overtreatment, the rate of which was higher than expected in our retrospective study. Long-term follow up is an imperative for proper assessment of the procedure success. This method is the best choice for complete disease removal without unnecessary overtreatment, but it requires continuous education and training of the whole team.
The 20-year experience with large loop excision of the transformation zone (LLETZ) at Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre ...from Zagreb is presented. This retrospective observational study included 1407 women with cervical dysplasia treated by LLETZ technique during the 1995-2016 period. LLETZ was most commonly performed in the 25-35 age group (51%), followed by the 36-45 age group (22%), and least frequently in the >65 age group (2%). Histopathologic results lower than high-grade squamous intraepithelial lesion were found in 23% and high grade squamous intraepithelial lesion or worse findings in 77% of patients. Positive margin as a sign of possible residual dysplasia was found in 25% of cones, 80% of which included endocervical positive margin. Cervical canal biopsy result was positive in 18% of cases. Accurate colposcopy and its findings can help avoid overtreatment, the rate of which was higher than expected in our retrospective study. Long-term follow up is an imperative for proper assessment of the procedure success. This method is the best choice for complete disease removal without unnecessary overtreatment, but it requires continuous education and training of the whole team. Keywords: Conization; Cervical intraepithelial neoplasia; Uterine cervical dysplasia; Colposcopy; Croatia Prikazuje se 20-godisnje iskustvo u primjeni tehnike large loop excision of the transformation zone (LLETZ) na Zavodu za opcu i onkolosku ginekologiju Klinike za zenske bolesti i porodnistvo, KBC Sestre milosrdnice. Ova retrospektivna studija obuhvatila je 1407 bolesnica s cervikalnom displazijom lijecenih ovom tehnikom u razdoblju od 1995. do 2016. godine. Metoda LLETZ najcesce se izvodila u dobnoj skupini od 25 do 35 godina (51%), zatim u dobnoj skupini od 36 do 45 godina (22%), dok je najmanje zastupljena skupina bila ona iznad 65 godina (2%). Histopatoloski nalaz skvamozne intraepitelne lezije niskog stupnja naden je u 23%, a skvamozna intraepitelna lezija visokog stupnja ili losiji nalaz u 77% bolesnica. Pozitivni rubovi kao znak moguce rezidualne displazije nadeni su u 25% konusa, od kojih je 80% ukljucivalo pozitivan endocervikalni rub. U 18% slucajeva biopsija cervikalnog kanala je bila pozitivna. U zakljucku, tocno izvodenje kolposkopskog pregleda pomaze da se izbjegne prekomjerno lijecenje koje je u nasoj studiji bilo vise od ocekivanog. Dugorocno pracenje nuzno je za pravilnu procjenu uspjesnosti zahvata. Ova metoda je najbolji izbor za potpuno uklanjanje bolesti bez nepotrebnog prekomjernog lijecenja, ali zahtijeva trajnu izobrazbu i obuku cijeloga tima. Kljucne rijeci: Konizacija; Cervikalna intraepitelna neoplazija; Cerviks uterusa, displazija; Kolposkopija; Hrvatska
Prikazuje se 20-godišnje iskustvo u primjeni tehnike large loop excision of the transformation zone (LLETZ) na Zavodu za opću i onkološku ginekologiju Klinike za ženske bolesti i porodništvo, KBC ...Sestre milosrdnice. Ova retro-spektivna studija obuhvatila je 1407 bolesnica s cervikalnom displazijom liječenih ovom tehnikom u razdoblju od 1995. do 2016. godine. Metoda LLETZ najčešće se izvodila u dobnoj skupini od 25 do 35 godina (51%), zatim u dobnoj skupini od 36 do 45 godina (22%), dok je najmanje zastupljena skupina bila ona iznad 65 godina (2%). Histopatološki nalaz skvamozne intraepitelne lezije niskog stupnja nađen je u 23%, a skvamozna intraepitelna lezi-ja visokog stupnja ili lošiji nalaz u 77% bolesnica. Pozitivni rubovi kao znak moguće rezidualne displazije nađeni su u 25% konusa, od kojih je 80% uključivalo pozitivan endocervikalni rub. U 18% slučajeva biopsija cervikalnog kanala je bila pozitivna. U zaključku, točno izvođenje kolposkopskog pregleda pomaže da se izbjegne prekomjerno liječenje koje je u našoj studiji bilo više od očekivanog. Dugoročno praćenje nužno je za pravilnu procjenu uspješno-sti zahvata. Ova metoda je najbolji izbor za potpuno uklanjanje bolesti bez nepotrebnog prekomjernog liječenja, ali zahtijeva trajnu izobrazbu i obuku cijeloga tima.
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