Geburtshilfe Frauenheilkd 2016; 76(12): 1339-1344
DOI: 10.1055/s-0042-113773
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

The Role of Surgeonsʼ Colposcopic Experience in Obtaining Adequate Samples by Large Loop Excision of the Transformation Zone in Women of Reproductive Age

Bedeutung der ärztlichen Erfahrung mit der Kolposkopie für die Entnahme adäquater Proben mittels LLETZ bei Frauen im gebärfähigen Alter
R. Sparić
1   Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
2   School of Medicine, University of Belgrade, Belgrade, Serbia
,
A. Tinelli
3   International Translational Medicine and Biomodeling Research Group Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow, Russia
4   Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy of Centre for Interdisciplinary Research Applied to Medicine Department of Obstetrics and Gynecology Vito Fazzi Hospital, Lecce, Italy
,
M. Guido
5   Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy
,
R. Stefanović
6   Department for Histopathology, Clinical Center of Serbia, Belgrade, Serbia
,
I. Babović
1   Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
2   School of Medicine, University of Belgrade, Belgrade, Serbia
,
V. Kesić
1   Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
2   School of Medicine, University of Belgrade, Belgrade, Serbia
› Author Affiliations
Further Information

Publication History

received 14 February 2016
revised 27 July 2016

accepted 28 July 2016

Publication Date:
05 September 2016 (online)

Abstract

Introduction: There is insufficient reporting on the level of colposcopic training for the safe use of large loop excision of the transformation zone. The aim of this study was to perform a quality assessment of large loop excision of the transformation zone in women of reproductive age by evaluating the surgeonsʼ colposcopic experience.

Materials and Methods: A retrospective cohort study was performed on diagnostic or therapeutic large loop excision of the transformation zone. The following variables were analyzed: age, parity, indications for surgery, level of surgeonʼs colposcopic experience, definitive histological diagnosis, margin involvement, and the presence and type of artifacts interfering with the pathological interpretation. Patients were divided into three groups: group A – 75 patients treated by junior colposcopists; group B – 74 patients treated by experienced colposcopists, and group C – 117 patients treated by expert colposcopists.

Results: Regarding the presence and diagnostic significance of the artifacts the groups were significantly different. Inadequate samples were the least frequent in group C. Artifacts precluding histological diagnosis were the most common in group A. The margins were predominantly inconclusive in group A.

Conclusions: A high rate of artifacts is a disadvantage of the large loop excision of the transformation zone performed by surgeons less skilled for colposcopy. Although large loop excision of the transformation zone is considered to be a minor surgery, skills in colposcopy are an essential prerequisite for optimal results.

Zusammenfassung

Einleitung: Es gibt nur wenige Berichte über die Bedeutung ausreichender Erfahrung in der Kolposkopie für die Sicherheit bei großflächigen Resektionen der Transformationszone. Ziel der Studie war es, die Qualität bei großflächigen Schlingenexzisionen der Transformationszone (LLETZ) zu bewerten, die bei Frauen im gebärfähigen Alter durchgeführt wurden. Es wurde untersucht, inwieweit die Qualität des Eingriffs mit der kolposkopischen Erfahrung des Chirurgen korrelierte.

Material und Methoden: Es wurde eine retrospektive Kohortenstudie bei Patientinnen durchgeführt, die einer diagnostischen oder therapeutischen LLETZ zugeführt wurden. Dabei wurden die folgenden Variablen untersucht: Alter, Anzahl vorhergehender Geburten, Indikationen zur chirurgischen Therapie, kolposkopische Erfahrung des Chirurgen, endgültige histologische Diagnose, Tumorfreiheit der Resektionsränder sowie Anwesenheit von und Art der Artefakte, die eine pathologische Diagnose nur einschränkt erlaubten. Die Patientinnen wurden in 3 Gruppen eingeteilt: Gruppe A bestand aus 75 Patientinnen, die von Assistenzärzten untersucht wurden, die noch nicht viel Erfahrung mit der Kolposkopie gesammelt hatten; Gruppe B bestand aus 74 Patientinnen, die von Ärzten mit mehrjähriger Erfahrung in der Kolposkopie behandelt wurden; Gruppe C bestand aus 117 Patientinnen, die von Fachärzten mit langjähriger Erfahrung in der Kolposkopie behandelt wurden.

Ergebnisse: Die Gruppen unterschieden sich signifikant im Hinblick auf die Anwesenheit von Artefakten und der diagnostischen Wertigkeit der entnommenen Proben. In der Gruppe C war die Anzahl inadäquater Proben am geringsten. Artefakte, die eine histologische Diagnose verhinderten, kamen am häufigsten in der Gruppe A vor. Bei den Frauen der Gruppe A waren die Resektionsränder meist nicht eindeutig.

Schlussfolgerung: Die höchste Artefaktrate bei der LLETZ fand sich in der Gruppe von Ärzten mit geringer Erfahrung in der Kolposkopie. Obwohl die großflächige Schlingenresektion der Transformationszone als kleiner Eingriff gewertet wird, ist eine langjährige Erfahrung in der Kolposkopie eine wesentliche Voraussetzung, um optimale Ergebnisse zu erzielen.

 
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