Efficacy of loop electrosurgical excision procedure with cold coagulation for treating cervical intraepithelial neoplasia: A two center cohort study

Abstract

ObjectiveTo evaluate the efficacy of loop electrosurgical excision procedure (LEEP) combined with cold coagulation for treating cervical intraepithelial neoplasia (CIN).MethodsWe reviewed clinic-pathologic data of 498 patients treated with LEEP alone (n=354), and LEEP combined with cold coagulation (n=144) between January 2000 and December 2011. After LEEP, we followed up all patients by using Papanicolaou smear and human papillomavirus (HPV) test, and evaluated abnormal cervical cytology-free interval and high-risk HPV infection-free interval. Moreover, we investigated independent factors affecting abnormal cervical cytology or high-risk HPV infection after LEEP.ResultsAbnormal cervical cytology-free interval was longer in patients treated with LEEP combined with cold coagulation than in those treated with LEEP alone (mean, 92.4 vs. 84.4 months; P=0.01), and patients treated with LEEP combined with cold coagulation also showed longer high-risk HPV infection-free interval than those treated with LEEP alone (mean, 87.6 vs. 59.1 months; P=0.01). Moreover, CIN 3 and cold coagulation were factors affecting abnormal cervical cytology after LEEP (adjusted hazard ratios, 1.90 and 0.61; 95% confidence intervals, 1.27 to 2.84 and 0.39 to 0.96), and CIN 3, positive deep cervical margin and cold coagulation were also factors affecting high-risk HPV infection after LEEP (adjusted hazard ratios, 2.07, 4.11, and 0.64; 95% confidence intervals, 1.38 to 3.08, 1.63 to 10.39, and 0.43 to 0.96). When we performed subgroup analyses for patients with CIN 2 or CIN 3, the result were similar.ConclusionLEEP combined with cold coagulation may be more effective for treating CIN than LEEP alone. Moreover, cold coagulation may decrease the risk of potential of recurrence after LEEP.

Comparative analysis of transcervical resection and loop electrosurgical excision in the treatment of high‐grade cervical intraepithelial neoplasia

“…Positive cone margins are an important predictor for CIN persistence/recurrence after conization . A meta‐analysis confirmed that positive cone margins significantly increases the risk of persistence/recurrence.…”

“…In the treatment of HSIL, TCRC resulted not only in lower incidences of positive margins, persistence, and recurrence than did LEEP, but Positive cone margins are an important predictor for CIN persistence/recurrence after conization. [12][13][14] A meta-analysis 15 confirmed that positive cone margins significantly increases the risk of persistence/recurrence. In the present study, TCRC resulted in lower rates of both positive cone margins and persistence/recurrence than did LEEP.…”

Lugol's Solution Reduces Positive Margins and Residual Disease After the Large Loop Excision of Transformation Zone

“…Still, there is potential tendency among physicians to use Lugol's solutions for cases of high-grade CINs. Other authors have reported similarly high proportions of endocervical margin involvement in up to 60%–75% of cases with positive RMs 23,24 . Lugol's solution helps visualize the TZ of the uterine ectocervix and therefore seems to have no role in aiding lesion removal from the endocervix.…”

“…Other authors have reported similarly high proportions of endocervical margin involvement in up to 60%-75% of cases with positive RMs. 23,24 Lugol's solution helps visualize the TZ of the uterine ectocervix and therefore seems to have no role in aiding lesion removal from the endocervix. As women age, the TZ gradually migrates into the endocervical canal, explaining the relatively higher proportion of older patients with CIN who have positive RMs.…”

Lugol’s solution reduces positive resection margins and residual disease after the loop electrosurgical excision procedure

“…In the Lugol's solution group, up to twothirds of cases with positive resection margins showed involvement of the endocervix. Other authors have reported similarly high proportions of endocervical margin involvement in up to 60 ~ 75% of cases with positive resection margins [23,24]. Lugol's solution helps to visualize the TZ of the uterine ectocervix and, therefore, seems to have no role in aiding lesion removal from the endocervix.…”