Non-Free Surgical Margins After LLETZ-LEEP

Abstract

Large Loop Excision of the Transformation Zone (LLETZ) is thought to be the treatment of choice for the high-grade precancerous lesions. The cone is also the “gold standard” specimen for the diagnosis of the underlying cervical disease once it includes the entire area of carcinogenesis for the squamous epithelium (transformation zone). In most research studies, therapeutic success after conization is a term generally assigned for disease clearance, that is, absence of residual high grade/CIN2+ histology by the end of a reasonable follow-up period, aiming at risk reduction for future recurrence and development of invasion. Conversely, positive cone margins as a reflection of an incomplete excision may, to some extent, represent a negative prognostic factor. Therefore, margin status may also be regarded as an indicator for the quality of a clinical service. The chapter summarizes all current evidence regarding optimal treatment of positive margins after LEEP.