Cervical cone measurements and residual disease in LLETZ conisation for cervical intraepithelial neoplasia.

AIM: To investigate the oncologically safe limits of excision in large loop excision of the transformation zone (LLETZ) conisation performed for cervical pathology. PATIENTS AND METHODS: A retrospective study conducted at the Colposcopy Unit in a University Hospital setting. Three hundred and sixty-one cases of LLETZ conisation were conducted in a 2-year period. Data concerning age, cone dimensions, lesion types and excision margins were recorded. RESULTS: The mean age of women was 36.7 years, with 181 (50.5%) low-grade squamous intraepithelial lesion cases, 166 (45.7%) high-grade squamous intraepithelial lesion, and 14 (3.8%) with stage-IA1 cervical carcinoma. Mean conisation depth and cone volume were 10.9 mm and 2.2 ml, respectively. Incomplete removal of lesions occurred in 25% of women and correlated to severity of cervical intraepithelial neoplasia and conisation depth. The higher the grade of the lesion, the greater the percentage of residual disease. Conisation depth exceeding 10 mm, in our cohort, led to significantly less residual disease. CONCLUSION: Results indicate that a conisation depth of <10 mm may be a risk factor predicting positive resection margins, while cone volume is an inappropriate clinical marker.

Dynamic spectral imaging: improving colposcopy.

PURPOSE: Colposcopy occupies a key role in the prevention of cervical cancer by identifying preinvasive or invasive lesions. However, colposcopy is subjective and is responsible for 52% of screening failures. Dynamic spectral imaging (DSI) is based on the objective, quantitative assessment of the acetowhitening effect. This study compared DSI with colposcopy. EXPERIMENTAL DESIGN: Women referred for colposcopy were examined simultaneously with colposcopy and DSI using a precommercial DySIS model (FPC-03) in an international, multicenter trial. The colposcopy impression and DySIS values were compared with consensus histology reports of biopsies. Subjects were recruited to a training group and subsequently to a test group. Measures were taken to avoid verification bias. RESULTS: The training and test groups comprised 82 and 308 eligible women, respectively. A cutoff value to identify high-grade disease was selected from the results of the training group and data from previous work. Receiver operator curve analysis of the test data showed an area under the curve of 0.844. DySIS detected 62.9% more high-grade cases than colposcopy (57 versus 35, P=0.0001). DySIS exceeded end points approved by the Food and Drug Administration for similar studies, with increments in the true positive rate of 22/308 (7.1%; lower 95% CL, 4.5% versus 2%) and in the false positive rate of 32/308 (10.4%; upper 95% CL, 14.7% versus 15%). CONCLUSIONS: DySIS is more sensitive than colposcopy in detecting high-grade lesions and can provide improved guidance for biopsy. The results are obtained in a user-independent fashion, making it suitable for use by nursing personnel.