Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100°C using the Semm cold coagulator: 14 years experience

Abstract

A total of 1628 women with CIN 3 treated with the Semm cold coagulator between 1975 and 1989 was followed primarily by cytology. The standard suitability criteria for ablation were adhered to except that patients were treated at their first visit when the colposcopist expected that the diagnosis would be no worse than CIN 3. Overall 97% of the women were treated at their first visit. In 30 women (2%) the histology was glandular or worse than expected, but 22 of these showed no persistent cervical disease subsequently. Follow-up was achieved for 87% at 10 years. In actuarial terms the primary success rate was 95% at 1 year and 92% at 5 years, it was similar for all age groups. Repeat coldcoagulation for persistenthecurrent CIN 3 was less successful and is not advised. The outcome for 226 pregnancies established after treatment is known. The rates for miscarriage, preterm or operative delivery were not increased. Cold-coagulation of CIN 3 at 100°C as performed by us is as effective as any other treatment and calls into question the need for more expensive practices.

A Double-Blind, Randomized, Placebo-Controlled Trial of Prilocaine and Felypressin (Citanest and Octapressin) for the Relief of Pain Associated with Cervical Biopsy and Treatment with the Semm Coagulator

“…Hussein and Galloway used no anesthetic in their series of 65 patients [14]. A Medline search of journals from 1966 to November 2004 entering the words ''Semm'' and ''coagulator'' does not list their article but yields 5 articles, the first three of which were written by the current first author [4,5,9]. The fourth is by Staland [15], who routinely used paracervical local anesthesia and local anesthetic spray.…”

“…Because of the distance from clinics and travel time, a ''see and treat'' approach is accepted by the National Health Service in Scotland [3]. The safety and cost-effectiveness of this approach using the Semm coagulator immediately after multiple colposcopically directed biopsies has been demonstrated [4,5]. The latest publication on guidelines for the NHS Cervical Screening Programme, which applies to England only now that health care within the United Kingdom is devolved, concedes this but advises that ''all patients must have a biopsy or biopsies taken before local destructive therapy'' and ''unless there are special circumstances, the result of the biopsy should be available (best practice)'' [6].…”

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

“…Cumulative evidence over the last three decades has demonstrated the effectiveness of thermo‐coagulation treatment . A recent systematic review and meta‐analysis of effectiveness of thermo‐coagulation summarised data from 13 studies, reporting on the analyses of proportion of patients cured, with results stratified by lesion grade and study region .…”

Outcome of cold coagulation for the treatment of cervical intraepithelial neoplasia in a department of genitourinary medicine.

“…5 No adverse effects were witnessed in either the short or long term. However, a proportion of women subsequently commented that they had experienced discomfort during treatment.…”