Messing M J, Otken L, King L A, Gallup D G
Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta 30912-3335.
Gynecol Oncol. 1994 Feb;52(2):207-11. doi: 10.1006/gyno.1994.1032.
Forty-six LLETZ cone biopsies were performed at the Medical College of Georgia from January 1991 through December 1991. All LLETZ cones were performed for diagnostic reasons following colposcopic biopsies. The majority of procedures were done by residents in obstetrics and gynecology with direct faculty supervision. All specimens were critically evaluated by one pathologist with regard to specimen orientation, thermal artifact, margins, histologic diagnosis, and overall specimen adequacy. The median number of specimens obtained per patient was two, with a maximum of eight. Sixteen patients had a separate endocervical specimen obtained. Thermal artifact was graded as slight in 16 cases, moderate in 18 cases, and severe in 12 cases. The transformation zone was identified in 33 cases. Margins were positive in 17 cases, negative in 21 cases, and nonevaluable in 8 cases. Only 13 LLETZ specimens were believed to compare in quality to a cold-knife cone biopsy. The main criticism about the specimens was the effect of thermal artifact on critical histologic evaluation. In three cases, the thermal artifact precluded an accurate enough evaluation to rule out microinvasion. Mucosa missing at the margins or inadequate representation of the transformation zone were major reasons to call a specimen inadequate. Endocervical specimens suffered the most thermal injury. Orientation of fragmented cone specimens present a problem in histologic evaluation. A major emphasis needs to be placed on the proper indications for LLETZ cone biopsy as well as education of practitioners and pathologists in proper specimen handling.
1991年1月至12月期间，在佐治亚医学院进行了46例环形电切术（LLETZ）锥形活检。所有LLETZ锥形活检均在阴道镜活检后出于诊断目的进行。大多数手术由妇产科住院医师在教员的直接监督下完成。所有标本均由一名病理学家对标本方向、热损伤、切缘、组织学诊断及整体标本充分性进行严格评估。每位患者获得标本的中位数为2个，最多为8个。16例患者获得了单独的宫颈管标本。热损伤分级为轻度16例，中度18例，重度12例。33例中识别出转化区。切缘阳性17例，阴性21例，无法评估8例。只有13例LLETZ标本被认为质量可与冷刀锥形活检相媲美。对标本的主要批评是热损伤对关键组织学评估的影响。3例中，热损伤妨碍了足够准确的评估以排除微浸润。切缘处黏膜缺失或转化区显示不充分是判定标本不充分的主要原因。宫颈管标本热损伤最严重。破碎锥形标本的方向给组织学评估带来问题。需要重点关注LLETZ锥形活检的恰当适应证，以及对从业者和病理学家进行恰当标本处理方面的培训。
