Perrotta M, Velazco A, Lugones L, Domenech M, Paván L

Language: Spanish
References: 18
Page: 1-8
PDF size: 596.86 Kb.

ABSTRACT

Introduction. Proper management of cervical intraepithelial neoplasia seeks to protect women from the risk of developing cervical carcinoma , and at the same time avoid over treatment as well as obstetric complications produced in those patients receiving invasive therapeutic .
Target. update our statistics using Escición LEEP Loop Electro Electrosurgical Injuries in cervical SIL AG .
Material and Methods . A retrospective study of 231 patients treated with LEEP SIL AG in the period March 2001 to March 2010 . In the 231 patients with SIL AG ectocervical excision was performed with handles of varying size and shape, based on the size of the cervix, of the lesion and the transformation zone type (ZT) present.
Results. The average age was 32.45 years. The lesions were located in the exocervix 204 patients (88%). Presented high-grade lesions 173 patients (74.89%), low-grade lesions 35 patients (15.15%), 4 patients had microinvasive carcinoma (1.73%) and in 20 no lesion was observed in the surgical specimen (8.66%). There was a correlation between the biopsy and the surgical specimen( LEEP) in 78% of cases. Were monitored 199 patients (86.15%), with a mean of 52 months (range 6-108 months). Were lost to follow up 32 patients (13.85%). Squamocolumnar junction was visible in the controls in 89% of patients. The LEEP cure rate was 94.8% (219 of 231). Persistence rate was 3.46% (8 out of 231). The recurrence rate was 1.29% (3 of 231). The resection margins were free of injury in 178 patients (77.06%) and engaged in 53 patients (22.94%).
Conclusions. The loop electrosurgical excision is the treatment of choice in high-grade intraepithelial lesions ectocervical or with minimum involvent of endocervical canal with junction visible.

REFERENCES

1. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 Consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis. 2007 Oct;11(4):223-39.

2. Martin-Hirsch PPL, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL. Surgery for cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD001318. DOI: 10.1002/14651858.CD001318.pub2

3. "Procedimiento de escision electroquirurgica con asa (LEEP) en el tratamiento del SIL de alto grado" Autores: M Perrotta, A Velazco, M Domenech, N Jacob. Revista Colposcopia, vol 19,Nª1, pag 18-23, 2008

4. Ferris et al. “See and treat” electerosurgical loop excision of the cervical transformacion zone. J fam Pract, 42 (3) 253-7, 1996

5. Ferenczy A et al. “ Management of patients with High Grade Squamous Intraepithelial Lesions. Cancer Supplement, Vol 76 N° 10 Nov 15,1995.

6. Guglielminetti A, y col. “ Nuestra experiencia en 10 años de resección electroquirúrgica de la Neoplasia Intraepitelial de Alto Grado de cuello uterino. 174 casos”. Revista de la Sociedad de Obstetricia y Ginecología de Buenos Aires, Vol 77, N° 993, 250-7 Septiembre. 1998.

7. Tyler LN, Andrews N, Parrish RS, Hazlett LJ, Korourian S. Significance of margin and extent of dysplasia in loop electrosurgery excision procedure biopsies performed for high grade squamous intraepithelial lesion in predicting persistient disease. Arch Pathol Lab Med 2007 Apr; 131 (4): 622-4.

8. Kim HJ, Kim KR, Mok JE, Nam JH, Kim YT, Kim YM, Kim JH, Yun SC. Pathologic risk factors for predicting residual disease in subsequent hysterectomy following LEEP conization. : Gynecol Oncol. 2007 May;105(2):434-8

9. Crimi G. y Col. “LLETZ en Lesiones Intraepiteliales de Alto Grado. Márgenes comprometidos o hallazgos de mayor patología” Colposcopía, Vol 9 N° 3, 1998

10. Tatti S y col. It is necessary to carry out a second Leep to patients treated with HG SIL with compromised borders. Abstract book. 10 Congreso Mundial de Patologia Cervical y Colposcopia. Nov 1999

11. Value of second pass in loop electrosurgical excisional procedure. Kim K, Kang SB, Chung HH, Lee TS, Kim JW, Park NH, Song YS.J Korean Med Sci. 2009 Feb;24(1):110-3. Epub 2009 Feb 28.

12. Predictors of recurrence in high-grade cervical lesions and a plan of management. Leguevaque P, Motton S, Decharme A, Soulé-Tholy M, Escourrou G, Hoff J.Eur J Surg Oncol. 2010 Nov;36(11):1073-9. Epub 2010 Sep 27.

13. Kietpeerakool C, Srisomboon J, Khobjai A, Chandacham A, Tucksinsook U. Complications of loop electrosurgical excision procedure for cervical neoplasia: a prospective study. J Med Assoc Thai. 2006 May;89(5):583-7

14. After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy.Ortoft G, Henriksen T, Hansen E, Petersen L.BJOG. 2010 Feb;117(3):258-67. Epub 2009 Nov 26

15. Pregnancy outcome after treatment for cervical intraepithelial neoplasia. - Shanbhag S – Obstet Gynecol – 01 OCT – 2009; 114(4): 727-35

16. Pregnancy outcome after treatment of cervical intraepithelial neoplasia by the loop electrosurgical excision procedure and cold knife conization. - Michelin MA – Clin Exp Obstet Gynecol – 01 JAN – 2009; 36(1): 17-9

17. Our experience with the LEEP/LLETZ technique in the diagnostics and treatment of the precancer lesions of the uterine cervix. Zlatkov V, Mikhova A, Kostova P. Akush Ginekol (Sofiia).Ginekologiia, 2004;43 Suppl 4:55-8.

18. Loop electrosurgical excision procedure: a valuable method for the treatment of cervical intraepithelial neoplasia. Fan Q, Tay SK, Shen K, Zhonghua Fu, Chan Ke, Za Zhi. Chinese Journal of Obst and Gynecology.eng.2001 May;36(5):271-4.