template design © 2008 outcome of large loop excision of transformation zone (lletz ) in women...
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Outcome of Large Loop Excision of Transformation Zone (LLETZ ) in women over forty at two London HospitalsOutcome of Large Loop Excision of Transformation Zone (LLETZ ) in women over forty at two London Hospitals
Collaborative audit between King’s College Hospital and Imperial St Mary’s Hospital.Collaborative audit between King’s College Hospital and Imperial St Mary’s Hospital. M Aziz,N Marcus,D LyonsM Aziz,N Marcus,D Lyons
Objectives
The prevalence of CIN 3 and invasive cancer in women over the age of 50 is low:
11 in 100,000 in well screened womenVersus…59 in 100,000 women in the population as a whole(1).
Large Loop Excision of Transformation Zone (LLETZ) is widely used procedure to treat Cervical Intraepithelial Neoplasia (CIN)
Advantages:Carried out in the out-patient clinic, simpleLocal anaesthesiaHistological examination of the entire Transformation Zone (TZ).
Risks of LLETZHaemorrhageInfectionDischarge and bleedingPainChanges in menstrual cyclePsychological impact
…. AND concerns of long-term pregnancy-related morbidity associated with excision in women of reproductive age group
While there are some concerns in treating young age group because of the risk of preterm labour, this is less of a concern in women over the age of forty, thus it is likely that we would treat low grade disease in women after the age of forty.
Retrospective study to review of LLETZ treatment in women over the Age of forty between two London hospitals - St Mary’s Hospital (SMH) and King’s College Hospital (KCH)
2007-2011- five year period
Audit proforma designed, anonymised data collected.
Manually transposed onto Excel spreadsheetData Analysis – each Unit.
Analysis especially with regards to outcomes of LLETZ
Analysis of over 40’s and under 40’s
Comparison of results/outcomes in each Unit
A total number of 2036 patients underwent excisional cervical treatment over five years between 2007-2011
There was 687 patients from KCH and 1376 patients from SMH .
Of those there were 575(28%)patients over the age the age of forty.
Patients characteristics
Conclusions
References
There is higher incidence of high grade lesions in under 40 group of both hospitals.
The incidence of CGIN was similar in both groups
There was slightly higher rate of microinvasive cancer at SMH over 40 group.
Older women had more LLETZ treatment and for less severe disease compared to younger women(<40) .
The difference thresholds for performing LLETZ in the two groups may be attributed to concerns over the risk of preterm labour in younger women.
OPTIONALLOGO HERE
OPTIONALLOGO HERE
PATIENTS CHATACTERISTICS (%)
65
79
43
24
75
49
0
10
20
30
40
50
60
70
80
90
SMOKING MULTIPS HG SMEAR
SMH
KCH
LESS THAN 40
MORE THAN 40
NO CIN/ HPV 32* (6.9%) 73* (32%)
HIGH GRADE 363(79%) 105 (47%)
LOW GRADE 58 (12.6%)
44(20%)
INVASIVE 2 (0.4%) 1 (0.4%)
CGIN 7 (1.5%) 2 (0.9%)
Referral cytology/ reason
LESS THAN 40
MORE
THAN 40
NO CIN 29* (2.7%) 14 * (5%)
HPV 102 ( 9.5%) 99(29%)
CIN1 228 (21.3%) 69(20.5%)
CIN2 284 (26.5%) 75(22.5%)
CIN3 400 (37.5%) 60(17%)
CGIN 17 (1.5%) 5 (1.5%)
MICRO/INVASIVE 10(1%) 12 (3.5%)
OTHER CANCERS
3(1%)
*Most of those patients LLETZ was done for clinical indications/PCB/Polyps. Negative LETZ reviewed at MDT
LESS THAN 40
MORE THAN 40
NO CIN/ HPV 32* (6.9%) 73* (32%)
HIGH GRADE 363(79%) 105 (47%)
LOW GRADE 58 (12.6%)
44(20%)
INVASIVE 2 (0.4%) 1 (0.4%)
CGIN 7 (1.5%) 2 (0.9%)
Treatment histology outcome KCH
Treatment histology outcome SMH
There is higher incidence of high grade lesions in under 40 group of both hospitals.
The incidence of CGIN was similar in both groups
There was slightly higher rate of microinvasive cancer at SMH over 40 group.
Results
1.NHSCSP Publication No 20 May 2010
ResultsMethods