The paper from Ørtoft et al.1 demonstrates a hazard to future pregnancy proportional to the length of cervical canal excised at conisation. In the same issue, Van de Vijver et al.2 further recommend that expectant management of all lesions should be considered in young women.
We question, however, whether these findings are relevant to current UK practice.
Measuring histological specimen size is difficult, and the technique of transport in saline, opening and stretching before fixation may result in different dimensions from those that we typically see in our practice.
The dimensions of the large loop excision of the transformation zone (LLETZ) specimens described by Ørtoft et al. were mean height of 15.8 ± 4.2 mm and mean ectocervical diameter (D = C/π) of 13.2 ± 2 mm. This suggests a long thin cone with a focus on excising the endocervical canal.
The vast majority of our patients undergoing the standard outpatient LLETZ procedure have a visible squamocolumnar junction (SCJ), and therefore excision of the transformation zone is effected by a much shallower excision of the order of 8–12 mm in depth. This would have less effect on future pregnancy, and our advice to patients should take account of this.
Finally, if one manages all lesions expectantly in young women, why screen them at all?