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Benefits of Direct Colposcopic Vision for Optimal LLETZ Procedure: A Prospective Multicenter Study

Preaubert, Lise MD1; Gondry, Jean MD, PhD2; Mancini, Julien MD, PhD3,4; Chevreau, Julien MD2; Lamblin, Gery MD5; Atallah, Anthony MD5; Lavoue, Vincent MD, PhD6; Caradec, Claire MD6; Baldauf, Jean-Jacques MD, PhD7; Bryand, Angélique7; Henno, Sebastien MD8; Villeret, Julia MD, PhD9; Agostini, Aubert MD, PhD10; Douvier, Serge MD, PhD11; Jarniat, Adelaide MD11; Riethmuller, Didier MD, PhD12; Mendel, Anne MD12; Brun, Jean-Luc MD, PhD13; Rakotomahenina, Hajanarina MD13; Carcopino, Xavier MD, PhD1

Journal of Lower Genital Tract Disease: January 2016 - Volume 20 - Issue 1 - p 15–21
doi: 10.1097/LGT.0000000000000156
Original Research Articles: Cervix and HPV

Objective The aim of the study was to assess whether direct colposcopic vision (DCV) of the cervix during large loop excision of the transformation zone (LLETZ) is associated with a decrease in the volume and dimensions of specimens or affects margin status at histology.

Materials and Methods A prospective multicenter observational study of 216 women who underwent LLETZ for grades 2 and 3 cervical intraepithelial neoplasia was conducted. The volume and dimensions (circumference, length, and thickness) of the surgical specimens were measured before fixation. Data were compared according to the use of colposcopy during LLETZ. The following 3 groups were considered: LLETZ performed without colposcopy (n = 91), LLETZ performed immediately after colposcopy (n = 51), and LLETZ performed under DCV (n = 74).

Results Patient characteristics were comparable with regard to age, parity, history of excision, indication of the procedure, and the size of the cervix. We found a significant decrease in all dimensions of the specimens obtained under DCV (p < .001). Margin status was not affected. After adjusting for confounders, the mean volumes were significantly lower in the DCV group (adjusted mean difference = −0.66 mL; 95% CI = −1.17 to −0.14). The probability that negative margins would be achieved together with the attainment of a volume less than 5 mL and a thickness less than 10 mm was the highest in the DCV group (adjusted OR = 2.80; 95% CI = 1.13 to 6.90).

Conclusions Direct colposcopic vision is associated with a significant decrease in the volume and in all dimensions of LLETZ specimens with no compromise in the margin status.

Direct colposcopic vision is associated with significant decrease in the volume and in all dimensions of LLETZ specimens with no compromise in the margin status.

1Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, CNRS, IRD, Avignon Université, Marseille; 2University Hospital of Amiens, Jules Verne University, Picardie; 3Aix Marseille Université, Inserm, IRD, UMR S912, SESSTIM; 4Public Health Department, APHM, Hôpital de la Timone, BioSTIC, Marseille; 5Department of Obstetrics and Gynaecology, Femme Mère Enfant University Hospital, Lyon-Bron; 6Teaching hospital of Rennes, Gynaecologic Department, University of Rennes 1, Rennes;7Department of Obstetrics and Gynaecology, Hospital of Hautepierre, Strasbourg University Hospitals, Strasbourg; 8Department of Pathology, CHU Pontchaillou, Rennes; 9Department of Pathology, HôpitalNord, Assistance Publique des Hôpitaux de Marseille, Marseille 10Department of Obstetrics and Gynaecology, Hopital La Conception, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Marseille; 11Department of Gynaecologic and Oncologic Surgery, CHU Dijon, Dijon; 12Pôle Mère-Femme, University Hospital Jean Minjoz, Besançon; and 13Pôle d'Obstétrique Reproduction Gynécologie, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, Bordeaux, France

Reprint requests to: Xavier Carcopino, MD, PhD, Department of Obstetrics and Gynaecology, Assistance Publique des Hôpitaux de Marseille (APHM) Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France. E-mail:

The authors have declared they have no conflicts of interest.

The study protocol received institutional approval from the ethics committee of the French College of Obstetricians and Gynaecologists, Paris, France, in October 2013 (CEROG 2013-GYN-1001).

X.C. and L.P. were the project leaders and designed the study. L.P., J.G., J.C., G.L., A.A., V.L., C.C., A.A., S.D., A.J., D.R., A.M., J.L.B., H.R., and X.C. collected the data. J.M., L.P., and X.C. analyzed the data. L.P., J.M., and X.C. wrote the article. All authors approved the final manuscript. The corresponding and last author had final responsibility for the decision to submit for publication.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology