The Use of Large Loop Excision of the Transformation Zone (LLETZ) in an Outpatient Setting


3 Department of Obstetrics and Gynaecology, Flinders Medical Centre, Bedford Park, South Australia 5042.


EDITORIAL COMMENT: We accepted this paper for publication because it presents a detailed analysis of the results from one centre of treatment of women with cervical intraepithelial neoplasia by large loop excision of the transformation zone. Importantly it provides a very careful review of the reported literature on the subject: the conclusions warrant special scrutiny.

Summary: An audit of the results of 129 patients treated in the first 12 months of operation of an outpatient large loop excision of the transformation zone (LLETZ) clinic was performed. It confirmed the efficacy of the procedure in treatment of cervical intraepithelial neoplasia (CIN) with a cure rate of 93.8%. Major deficiencies identified were the lack of compliance with recommended follow-up, a major discrepancy between predicted diagnosis on colposcopically directed punch biopsy and LLETZ specimen histology, and a large proportion of LLETZ specimens which had negative histology and may be regarded as overtreatment. Suggested strategies to address these include observation of low-grade lesions and treatment with LLETZ at the first clinic appointment.