Image assessment of cervical dimensions after LLETZ: a prospective observational study

Abstract

Objective: To assess the impact of large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia (CIN) on cervical morphology as assessed by three-dimensional ultrasound.

Design: Prospective observational study.

Setting: University Hospital in Dublin.

Population: Women with CIN who underwent an LLETZ procedure.

Methods: All 106 participants had a three-dimensional transvaginal ultrasound scan (3DTVS) performed immediately before and 6 months after LLETZ. The excised LLETZ specimen dimensions were also recorded. Blind analysis of the images was performed. The volume of the uterus and cervix was documented.

Main outcome measures: The relationship between the extirpated LLETZ dimensions and subsequent cervical and uterine biometry, as assessed by 3DTVS.

Results: LLETZ induced a statistically significant reduction in both the length (mean, -0.46 cm; P < 0.001) and the volume (-6.12 cm(3) ; P < 0.001) of the uterus, and in the volume of the cervix (-1.60 cm(3) ; P < 0.001). The volume of the excised specimen had a significant impact on the reduction of the length of the uterus (β, -0.038; P = 0.012), the volume of the uterus (β, -0.791; P = 0.036) and the volume of the cervix (β, -0.121; P = 0.046). The circumference of the excised specimen appeared to have a significant impact on the length (β, -0.016; 95% CI, -0.028 to -0.003; P = 0.013) and volume (β, -0.413; 95% CI, -0.719 to -0.107; P = 0.009) of the uterus 6 months after LLETZ.

Conclusions: The volume of tissue removed at LLETZ is related to the subsequent cervical volume, as well as the uterine length and volume, 6 months after the procedure.