Loop diathermy excision compared with cervical laser vaporisation for the treatment of intraepithelial neoplasia: a randomised controlled trial

Abstract

Objective: To determine whether loop diathermy excision of the transformation zone and laser vaporisation are equally effective in the treatment of cervical intraepithelial neoplasia.

Design: Randomised controlled trial.

Population: Women referred for evaluation of cytological abnormality who were considered suitable for outpatient local destructive treatment.

Setting: Seven colposcopy units in the North West Region.

Methods: Loop diathermy excision of the transformation zone and laser vaporisation.

Main outcome measure: Smear reported as moderate dyskariosis or worse following treatment.

Results: Of 289 women randomised, 285 had one or more smears following treatment. Women were more likely to have a smear reported as moderate dyskariosis or worse following laser vaporisation [hazard ratio 3.01 (95% CI 1.27 to 7.12)]. The cumulative risk of a smear reported as moderate dyskariosis or worse was 6.0% at six months and 12.1% at three years in those allocated laser vaporisation, and 2.0% at six months, and 3.3% at three years in those allocated loop diathermy excision of the transformation zone.

Conclusions: Loop diathermy excision is a more effective treatment of cervical intraepithelial neoplasia than laser vaporisation.