Cold Knife Conization and Loop Excision for Cervical Intraepithelial Neoplasia

Takač, Iztok; Gorišek, Borut

doi:10.1177/030089169908500406

Cited by 18 publications

(15 citation statements)

References 9 publications

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“…This also explains why the LEC1 group exhibited a greater need for hemostatic suturing when compared to the LEC2 group, and to previous reports [18,19] . The higher need for haemostatic suture may also have occurred because we routinely perform an LEC of large lesions with 2 passes and, in this study, when a patient with a large lesion was assigned to the procedure with one pass, the surgeon was not allowed to change the procedure to two passes.…”

Section: Discussionsupporting

confidence: 83%

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

Rivoire

Monego

Reis

et al. 2009

Gynecol Obstet Invest

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The use of loop electrosurgical conization (LEC) for the treatment of large high-grade cervical intraepithelial neoplasias (CINs) is often associated with a difficult procedure that results in accidental sample fragmentation, thermal damage and sometimes the presence of positive margins. This study aims to compare LEC that removes the cervical cone in two blocks (anterior and posterior cervical lips – LEC2) with LEC performed with one pass of the loop (LEC1). In a randomized, controlled trial, patients that needed conization due to high-grade CIN were assigned to one of the techniques. There were no differences in terms of age, cone histopathological diagnosis, blood loss, vaginal injuries, stenosis of the cervical os and specimen artifacts. LEC2 required less hemostatic sutures. LEC2 showed no specimen fragmentation, while LEC1 did (0 vs. 5.9%; p = 0.10). As expected, LEC2 samples were heavier (p = 0.01), included a larger ectocervical area (p = 0.001) and, therefore, had a greater volume (p < 0.001) compared to LEC1 samples. The height of the LEC2 specimens was smaller than that of LEC1 specimens (p < 0.001). LEC2 yielded fewer cases of positive margins (12.7%) than LEC1 (33.3%; p = 0.021). We conclude that the LEC2 technique is an effective treatment choice: it is safe for the patient, with better outcomes regarding sample quality than LEC1. Further studies are encouraged regarding this procedure.

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Section: Discussionsupporting

confidence: 83%

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

Rivoire

Monego

Reis

et al. 2009

Gynecol Obstet Invest

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“…After eliminating duplicates, 51 records were left for abstract reading, with 42 articles eliminated. After applying the selection criteria and after reading the full text, eight original articles were selected [15][16][17][18][19][20][21] ( Table 1). The article by Huang et al 22 was excluded because it was not a randomized controlled study.…”

Section: Resultsmentioning

confidence: 99%

“…Six of the included studies assessed treatment of CIN with cold cone compared with LEEP 15,16,[19][20][21] , two studies assessed treatment with cryotherapy compared to LEEP 17,18 . No studies were identified assessing treatment of CIN with thermocoagulation compared with LEEP.…”

Section: Resultsmentioning

confidence: 99%

“…The studies showed no significant heterogeneity (P = 0.65 and I 2 = 0%) ( Figure 2A). Four studies assessed residual disease 15,16,19,21 . Residual disease was reported in 6.1% of patients treated with cold cone and in 11.2% of those treated with LEEP.…”

Section: Resultsmentioning

confidence: 99%

“…Four included studies assessed this outcome 15,16,20,21 . The prevalence of minor bleeding in patients treated with cold cone was 5.7% and in those treated with LEEP 5.4%.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review

2020

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OBJECTIVES: To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS: Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS: The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30–0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16–2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08–1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40–0.59, p ≤ 0.001). CONCLUSIONS: The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.

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Surgery for cervical intraepithelial neoplasia

Martin-Hirsch

Paraskevaidis

Kitchener

1999

Cochrane Database of Systematic Reviews

155

171

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Cold Knife Conization and Loop Excision for Cervical Intraepithelial Neoplasia

Abstract: The results suggest that cold knife conization and loop excision are comparable and equally effective diagnostic and therapeutic procedures for CIN.

Cited by 18 publications

References 9 publications

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review

Surgery for cervical intraepithelial neoplasia

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