National Women's Annual Clinical Report 2010

The number of treatments and percentage that are LLETZ has remained fairly constant.
LLETZ has been shown to have less morbidity than other forms of treatment, and should
be the treatment of choice. All methods are excisional and therefore provide histology,
and ablative treatments are not performed. The diathermy included in the table was not
for treatment of cervical neoplasia, but treatment of a bleeding ectropion. Eighty-five
percent of LLETZ were performed in the clinic and under local anaesthesia.
In 2009 no patient under the age of 20 underwent treatment for abnormal smears. One
woman was treated under the age of 20 in 2010 and 31 women under the age of 25
were treated. Conservative management after MDM review of women under the age of
25 presenting with biopsy proven CIN2 is expected standard management at NW. The
policy also requires discussion at a Multidisciplinary Meeting and compulsory pathology
review of all patients considered for treatment under the age of 20.
As there is increasing evidence that even one treatment can have a detrimental effect on
future pregnancies, review of all cases under the age of 25 should be considered. This
is reasonable considering WHO recommendations that screening should start at 25,
given the low prevalence of cervical cancer before this age.
12.8.1 Post treatment follow up
Colposcopy Standard: Follow up after treatment Standard
NW
2008
NW
2009
NW
2010
Indicator Definition % % % %
Numerator
Follow up visit no later than 8 months following
treatment
>90 88 88 81
Denominator All treatments
Table 122: Timing of follow up colposcopy after treatments (2007-2009)
2007
2008
2009
N=191
N=213
N=199
n % n % n %
< 8 months 168 88.0 182 85.5 162 81.4
> 8 months 3 1.6 3 1.4 4 2.0
No follow up 20 10.5 28 13.2 33 16.6
There has been a drop in this indicator in 2010. Those cases outside the recommended
indicator will be reviewed.
Colposcopy Standards: Dyskaryosis* after treatment Standard NW
2008
NW
2009
NW
2010
Indicator Definition % % % %
Numerator
Treated women with no dyskaryosis* following
treatment
>90% 90 92 76
Denominator All treatments
*HSIL or LSIL on cytology
The decline in this indicator is of concern to the service and will be reviewed.
195