Hekman, M.C.H. (2013) Afwijkende cytologie na een lisexisie : Het effect van de operateur. thesis, Medicine.
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Abstract
Background: In the Netherlands LEEP (Loop Electrosurgical Excision Procedure) is treatment of choice for cervical intraepithelial neoplasia (CIN). Complication risk is low and effectiveness is high: 70% to 95% of patients has normal cytology after treatment. Thermal artifacts may be a disadvantage of the technique. It is assumed that effectiveness of LEEP is higher among oncological gynaecologists compared to general gynaecologists. The objective of this study is to test this assumption. Methods: This retrospective cohort study was performed in Medisch Spectrum Twente, a teaching hospital in the Netherlands. Medical records of patients who underwent LEEP between July 2009 and December 2011 were reviewed. LEEP results from oncological and general gynaecologists were compared for cytology after six months, treatment for residual disease and complications. Besides we independently reviewed part of LEEP specimens to compare for resection margins, limitations of interpretability and artifacts. Logistic regression was used to correct for confounders. Results: In total 349 patients were included, 227 operated by oncological gynaecologists and 122 by general gynaecologists. Percentages of abnormal cytology six months after LEEP were 8.0% and 16.7% respectively (OR 0.40, 95%-CI 0.20-0.80). Oncological gynaecologists’ patients underwent less frequent treatment for residual disease (OR 0.36, 95%-CI 0.17-0.78), but there was no difference in complications (OR 0.95, 95%-CI 0.51-1.77). A total of 147 LEEP specimens were reviewed. There was neither difference in limitations of interpretability (OR 1.07, 95%-CI 0.54-2.15) nor in artifacts (OR 2.15, 95%-CI 0.80-5.81) between gynaecologists. Oncologists removed more tissue fragments and therefore had higher rates of positive resection margins (OR 2.24, 95%-CI 1.01-4.97). Positive resection margin did not correlate with abnormal cytology in follow-up. Conclusion: Our results confirm the assumption that effectiveness of LEEP is higher among oncological gynaecologists compared to general gynaecologists. It is therefore eligible to restrict LEEP technique to oncological gynaecologists only. Complications and artifacts did not differ between gynaecologists. Positive resection margins in fragmented specimens are less predictive of abnormal cytology after LEEP.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Schutter, Dr. E.M.J. and Afdeling Obstetrie & Gynaecologie and Medisch Spectrum Twente, Enschede |
| Supervisor name: | Peters, Dr. H.M. patholoog and Laboratorium pathologie Oost-Nederland, Enschede |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2316 |
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