Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct-Dec;7(4):145-151.
doi: 10.4103/GMIT.GMIT_56_18. Epub 2018 Sep 26.

Loop Electrosurgical Excision Procedure versus Cryotherapy in the Treatment of Cervical Intraepithelial Neoplasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Pietro D'Alessandro  1 , Bruno Arduino  1 , Maria Borgo  1 , Gabriele Saccone  1 , Roberta Venturella  2 , Annalisa Di Cello  1 , Fulvio Zullo  1
Affiliations
Review

Loop Electrosurgical Excision Procedure versus Cryotherapy in the Treatment of Cervical Intraepithelial Neoplasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Pietro D'Alessandro et al. Gynecol Minim Invasive Ther. 2018 Oct-Dec.

Abstract

Aim: Invasive cervical cancer is proceeded by a phase of preinvasive disease that is slow to progress and can be detected, treated, and collectively referred to as cervical intraepithelial neoplasia (CIN). Several excisional and ablative treatments for CIN have been studied, with loop electrosurgical excision procedure (LEEP) and cryotherapy being the two most commonly utilized. The objective of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to compare the compare harms and benefits of LEEP versus cryotherapy in women with CIN.

Methods: Electronic databases were searched from their inception until May 2018. We included all RCTs comparing cryotherapy versus LEEP in women with CIN. We included trials evaluating both HIV-seropositive and HIV-seronegative women. The primary outcome was the persistence of the disease at 6-month follow-up. Meta-analysis was performed using the random-effects model to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI).

Results: Four trials, including 1035 women with CIN, were identified as relevant and included in the meta-analysis. Women who received LEEP for CIN had a significantly lower persistence at 6-month follow-up biopsy (RR: 0.87, 95% CI: 0.76-0.99) and significantly lower recurrence at 12-month follow-up biopsy (RR: 0.91, 95% CI: 0.84-0.99) compared to those who received cryotherapy. No between-group differences were found in the complications rate, but the analyses were not powered for these outcomes.

Conclusions: In women with CIN, treatment with LEEP was associated with a significantly lower risk of persistence disease at 6 months and recurrence disease at 12 months compared to treatment with cryotherapy.

Keywords: Cervical cancer; Pap test; cervical intraepithelial neoplasia; colposcopy; gynecology.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of studies identified in the systematic review (Preferred Reporting Items for Systematic Reviews and Meta-Analyses template)
Figure 2
Figure 2
Assessment of risk of bias. (a) Summary of risk of bias for each trial; plus sign: low risk of bias; minus sign: high risk of bias; question mark: unclear risk of bias. (b) Risk of bias graph about each risk of bias item presented as percentages across all included studies
Figure 3
Figure 3
Forest plot for the risk of persistence of the disease, defined as any grade of cervical intraepithelial neoplasia at the biopsy 6 months after the procedure
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Parkin DM. Cancer in developing countries. Cancer Surv. 1994;19-20:519–61. - PubMed
    1. Castle PE, Schiffman M, Wheeler CM, Solomon D. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol. 2009;113:18–25. - PMC - PubMed
    1. McCredie MR, Sharples KJ, Paul C, Baranyai J, Medley G, Jones RW, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: A retrospective cohort study. Lancet Oncol. 2008;9:425–34. - PubMed
    1. Jones HH. Treatment of cervical intraepithelial neoplasia. Clin Obstet Gynecol. 1990;33:826–36. - PubMed
    1. De Vuyst H, Lillo F, Broutet N, Smith JS. HIV, human papillomavirus, and cervical neoplasia and cancer in the era of highly active antiretroviral therapy. Eur J Cancer Prev. 2008;17:545–54. - PubMed