COMPARISON OF PREOPERATIVE CYTOLOGICAL AND PATHOHISTOLOGICAL DIAGNOSIS WITH FINAL PATHOHISTOLOGICAL DIAGNOSIS IN PATIENTS WITH CERVICAL LESIONS TREATED WITH CONIZATION AND LLETZ

Abstract

Objective: The primary aim of this study was to compare the relationship between preoperative cytological and pathohistological diagnosis with the final pathohistological diagnosis in patients with cervical lesions treated with conization and LLETZ. As a secondary objective, a comparison of certain parameters (age, parity, hospital stay, sample volume, proportion of sample with clear margins, incisional surgery) was made between patients treated with conization and LLETZ.

Materials and methods: It is a retrospective study conducted at KBC Split with a total number of 550 subjects who underwent surgery from January 1, 2014, to January 1, 2019, where the medical history of those operated on was analyzed. The observed parameters are age, parity, days of hospitalization, size and edges of the cone, previous surgery, diagnosis of Pap test, PHD of biopsy before surgery, and PDH of surgical specimen and treatment method.

Results: Out of 550 patients, 360 were operated with conization and 190 with LLETZ. Subjects treated with conization were significantly older than those treated with LLETZ (40.47 ± 10.28 vs. 36.29 ± 10.05 years, P<0.001). Furthermore, subjects treated with LLETZ had a significantly shorter duration of hospitalization (3.56 ± 1.08 vs. 1.99 ± 1.16 days, P<0.001), smaller sample volume (10.78 ± 9.86 cm3 vs. .6.57 ± 4.68 cm3, P<0.001), but also a smaller proportion of samples with clean edges (329 (91.38%) 158 (83.16%) P=0.006). Significant differences in parity, as well as the type of previous operation, were not proven. There are statistically significant differences in the distribution of certain diagnoses of the cytological findings of the preoperative Pap test LSIL 6 (1.80%); 22 (11.60%) and HSIL 322 (89.30%); 151 (79.50%) and the histological findings of the surgical specimen LSIL
21 (5.80%); 16 (8.40%) and HSIL 311 (86.40%); 151 (79.50%) between patients treated with conization and LLETZ, while there were no differences in the preoperative biopsy histological findings . There are statistically significant differences in the distribution of different types of cervical intraepithelial neoplasia according to the histological findings of the preoperative biopsy CIN 112 (3.40%); 8 (4.30%); CIN 2 70 (19.30%); 58 (30.50%), CIN 3278 (77.30%); 124(65.20%) P=0.031 and the histological findings of the surgical specimen CIN 130 (8.20%), 23(11.90%); CIN 2 31 (8.60%) 35 (18.50%); CIN 3 299 (83.10%) 132 (69.60%), P=0.005. Significant differences were observed between different sampling methods, the preoperative Pap test cytological findings, the preoperative
biopsy histological findings, and histological findings of the surgical specimen, P<0.001.

Conclusions: This study demonstrated significant differences in diagnoses according to the LAST classification in the preoperative Pap test’s cytological findings and the surgical sample’s histological findings between patients treated with conization and LLETZ. Significant differences were noted in diagnoses based on the Bethesda classification in the preoperative biopsy findings and the histological findings of the surgical specimen between patients treated with conization and LLETZ. Furthermore, there are significant differences in the diagnoses between different sampling methods (the preoperative Pap test cytological findings, the
preoperative biopsy histological findings, and histological findings operating sample). Patients operated on by conization are older than patients operated on by LLETZ. There is no significant difference in parity, nor previous surgery between patients treated by conization and LLETZ. LLETZ-operated patients were hospitalized for a shorter time compared to conisation-operated patients. The sample of conisation has a larger volume than samples taken by LLETZ, as well as a higher proportion of samples with clean edges compared to samples taken by LLETZ surgery.