TEMPLATE DESIGN © Outcome of Large Loop Excision of Transformation Zone (LLETZ ) in women over forty at two London Hospitals Outcome of Large Loop Excision of Transformation Zone (LLETZ ) in women over forty at two London Hospitals Collaborative audit between King’s College Hospital and Imperial St Mary’s Hospital. Collaborative audit between King’s College Hospital and Imperial St Mary’s Hospital. M Aziz,N Marcus,D Lyons M Aziz,N Marcus,D Lyons Objectives The prevalence of CIN 3 and invasive cancer in women over the age of 50 is low: 11 in 100,000 in well screened women Versus… 59 in 100,000 women in the population as a whole(1). Large Loop Excision of Transformation Zone (LLETZ) is widely used procedure to treat Cervical Intraepithelial Neoplasia (CIN) Advantages: Carried out in the out-patient clinic, simple Local anaesthesia Histological examination of the entire Transformation Zone (TZ). Risks of LLETZ Haemorrhage Infection Discharge and bleeding Pain Changes in menstrual cycle Psychological impact …. AND concerns of long-term pregnancy- related morbidity associated with excision in women of reproductive age group While there are some concerns in treating young age group because of the risk of preterm labour, this is less of a concern in women over the age of forty, thus it is likely that we would treat low grade disease in women after the age of forty. Retrospective study to review of LLETZ treatment in women over the Age of forty between two London hospitals - St Mary’s Hospital (SMH) and King’s College Hospital (KCH) five year period Audit proforma designed, anonymised data collected. Manually transposed onto Excel spreadsheet Data Analysis – each Unit. Analysis especially with regards to outcomes of LLETZ Analysis of over 40’s and under 40’s Comparison of results/outcomes in each Unit A total number of 2036 patients underwent excisional cervical treatment over five years between There was 687 patients from KCH and 1376 patients from SMH. Of those there were 575(28%)patients over the age the age of forty. Patients characteristics Conclusions References There is higher incidence of high grade lesions in under 40 group of both hospitals. The incidence of CGIN was similar in both groups There was slightly higher rate of microinvasive cancer at SMH over 40 group. Older women had more LLETZ treatment and for less severe disease compared to younger women(<40). The difference thresholds for performing LLETZ in the two groups may be attributed to concerns over the risk of preterm labour in younger women. OPTIONAL LOGO HERE LESS THAN 40 MORE THAN 40 NO CIN/ HPV32* (6.9%)73* (32%) HIGH GRADE363(79%)105 (47%) LOW GRADE58 (12.6%) 44(20%) INVASIVE2 (0.4%)1 (0.4%) CGIN7 (1.5%)2 (0.9%) Referral cytology/ reason LESS THAN 40 MORE THAN 40 NO CIN29* (2.7%)14 * (5%) HPV102 ( 9.5%)99(29%) CIN1228 (21.3%)69(20.5%) CIN2284 (26.5%)75(22.5%) CIN3400 (37.5%)60(17%) CGIN17 (1.5%)5 (1.5%) MICRO/INVASIVE10(1%)12 (3.5%) OTHER CANCERS 3(1%) * Most of those patients LLETZ was done for clinical indications/PCB/Polyps. Negative LETZ reviewed at MDT LESS THAN 40 MORE THAN 40 NO CIN/ HPV32* (6.9%)73* (32%) HIGH GRADE363(79%)105 (47%) LOW GRADE58 (12.6%) 44(20%) INVASIVE2 (0.4%)1 (0.4%) CGIN7 (1.5%)2 (0.9%) Treatment histology outcome KCH Treatment histology outcome SMH There is higher incidence of high grade lesions in under 40 group of both hospitals. The incidence of CGIN was similar in both groups There was slightly higher rate of microinvasive cancer at SMH over 40 group. Results 1.NHSCSP Publication No 20 May 2010 ResultsMethods