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

Abstract

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.

LEEP Verses Cryotherapy in CIN

“…Efficacy of multiple pass procedure of LEEP was slightly better than single pass procedure with fewer cases of positive margin and less bleeding which is in correlation with the finding of Rivoire et al [10] (see Table 2). White discharge followed by lower abdominal pain and backache were the most common complaints of the women in both Cryosurgery and LEEP group.…”

Analysis of Residual/Recurrent Disease and Its Risk Factors after Loop Electrosurgical Excision Procedure for High-Grade Cervical Intraepithelial Neoplasia

“…Moreover, LEEP has been recommended as a conservative excision technique in the 2006 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines [3]. LEEP is an effective and safe treatment for high-grade cervical intraepithelial neoplasias [4]. …”