[Diathermy excision using a metal loop in the treatment of cervical intra-epithelial neoplasms; short-term results in 154 patients]

Abstract

Intraepithelial neoplasia of the uterine cervix (CIN), proven in colposcopically guided biopsies, can be treated in several ways. With the destruction techniques the lesion is treated by laser evaporation or by cryocoagulation. With the excision methods the transformation zone is excised by cold knife conisation, by laser exconisation or by large loop excision (LLETZ). LLETZ was developed by Cartier in 1977 and can be performed under local anaesthesia on an outpatient basis. In the current investigation 154 women with CIN were treated by LLETZ. In four patients microinvasion was suspected after pathological examination and cold knife conisation was performed, so that 150 patients were available for cytological follow-up after three and six months. After 1989 larger loops and more loops of different sizes were used. Therefore the results in both groups are presented separately. In 22 women CIN residue was found. The treatment in the first period of the study (1985-1988) was effective in 36 of the 55 cases (65%), that in the second period (1989-1991) in 87 of the 95 cases (93%). In the first period the size and endocervical localisation of the lesion significantly affected predict the result of the LLETZ, in the second half of the study these were no longer relevant. Destruction methods lack the possibility of pathological investigation, which is possible with the excision methods. In this way underestimation by the colposcopist of a (micro)invasive carcinoma does not necessarily delay adequate treatment.