Surgery for cervical intraepithelial neoplasia

Abstract

Background Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Atypical squamous changes occur in the transformation zone of the cervix with mild, moderate or severe changes described by their depth (CIN 1, 2 or 3). Cervical intraepithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the grade and extent of the disease. Objectives To assess the effectiveness and safety of alternative surgical treatments for CIN. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (up to April 2009). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Selection criteria Randomised controlled trials (RCTs) of alternative surgical treatments in women with cervical intraepithelial neoplasia. Data collection and analysis Two review authors independently abstracted data and assessed risks of bias. Risk ratios that compared residual disease after the follow-up examination and adverse events in women who received one of either laser ablation, laser conisation, large loop excision of the transformation zone (LLETZ), knife conisation or cryotherapy were pooled in random-effects model meta-analyses. Main results Twenty-nine trials were included. Seven surgical techniques were tested in various comparisons. No significant differences in treatment failures were demonstrated in terms of persistent disease after treatment. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity. Morbidity was lower than with laser conisation, although the trials did not provide data for every outcome measure. There were not enough data to assess the effect on morbidity when compared with laser ablation. Authors’ conclusions The evidence suggests that there is no obvious superior surgical technique for treating cervical intraepithelial neoplasia in terms of treatment failures or operative morbidity.

Treatment of Cervical Intraepithelial Neoplasia With Topical Imiquimod

“…5 In most countries, the excisional procedure, ie, conization, is the preferred treatment. 5 In most countries, the excisional procedure, ie, conization, is the preferred treatment.…”

Three-Tiered versus Two-Tiered Classification of Squamous Dysplasia in Cervical Cytology: Results of a Follow-Up Study

“…For CIN3, there is an international consensus regarding the need for treatment [19, 20]. By contrast, clinical management is inconsistent for CIN2 findings [21-24].…”

Cancer in developing countries: The next most preventable pandemic. The global problem of cancer

“…On the other hand, cryotherapy costs substantially less, does not require electricity (it only needs transportable tanks of compressed refrigerant gases) and does not require local anesthetic [26]. Metaanalysis of randomized clinical trials evaluating the effectiveness of cryotherapy with LEEP, conization and laser concluded that all above treatment were equally effective [27] Therefore, and provided the lesion is located in the ectocervix, cryotherapy is the treatment of choice. LEEP is used in the treatment of lesions that involve the endocervical canal.…”