Journal article
Treatment of Cervical Intraepithelial Neoplasia in a Prospective Study Comparing Large-Loop Excision of the Transformation Zone, Laser Vaporization, and Knife Cone Biopsy
Journal of lower genital tract disease, Vol.1(4), pp.229-233
10/1997
DOI: 10.1097/00128360-199710000-00006
PMID: 25951208
Abstract
Objective.
Our aim was to compare cervical intraepithelial neoplasia (CIN) treatment results in the use of large-loop excision of the transformation zone (LLETZ), laser vaporization, and cold-knife cone biopsy.
Materials and Methods.
We included in the study patients with CIN lesions diagnosed at the Hospital Universitario Materno-Infantil Vall d'Hebron and Hospital Clinic i Provincial de Barcelona, Barcelona, Spain, between March 1991 and March 1994. Patients with unsatisfactory colposcopy were excluded from the study. One hundred twenty-three patients were included in this study: 98 patients were compared for LLETZ treatment versus laser vaporization, and 69 CIN3 patients were compared for three treatments: LLETZ, laser vaporization, and knife cone biopsy. Patients were followed at 3-month intervals for at least 1 year. Follow-up included physical examination, cervical Papanicolaou (Pap) smear, cervical colposcopy, and a colposcopically guided biopsy when required. Treatment failure (persistence or recurrence) was defined by the presence of CIN confirmed histologically by a colposcopically guided biopsy.
Results.
The mean age of patients was 34.1 years. The agreement between histology from the colposcopically guided biopsy and the surgical specimen was 60%, and the kappa coefficient was 40.7% (moderate agreement). Three cases of microinvasive carcinoma were diagnosed in patients whose initial diagnosis was CIN3 on colpobiopsy (4% of invasion in the initial CIN3 group of patients). In a comparison of LLETZ with laser treatment for all CIN grades, the unique independent prognostic factor for persistence-recurrence of the disease was the colposcopic size of the primary lesion (relative risk, 4.9; Cl, 1.33-18.45).
Conclusions.
We conclude that the LLETZ procedure for CIN treatment demonstrates an advantage over destructive methods for detection of occult microinvasive and invasive cancer. This process is a simple outpatient technique with the same failure as that of laser vaporization in all CIN grades. In the treatment of CIN3, cold-knife cone biopsy had better cure rates. Close follow-up is required in these patients, because of their risk of developing recurrent CIN or invasive carcinoma.
Details
- Title: Subtitle
- Treatment of Cervical Intraepithelial Neoplasia in a Prospective Study Comparing Large-Loop Excision of the Transformation Zone, Laser Vaporization, and Knife Cone Biopsy
- Creators
- Jesús González-BosquetCristina CentenoBegoña BermejoPere JouLuis-Maria Puig-TintoréJordi XercavinsJesús González-Merlo - Hospital Clínic de Barcelona
- Resource Type
- Journal article
- Publication Details
- Journal of lower genital tract disease, Vol.1(4), pp.229-233
- DOI
- 10.1097/00128360-199710000-00006
- PMID
- 25951208
- ISSN
- 1089-2591
- eISSN
- 1526-0976
- Language
- English
- Date published
- 10/1997
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984315573002771
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