Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials

Abstract

Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have been made in the last decade. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled clinical trials reporting on the efficacy and safety of diagnostic and therapeutic interventions for cervical dysplasia. Data were analyzed according to PRISMA guidelines. In total, 33 studies reporting on 5935 women were identified. We recommend intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored 1 min after the application of acetic acid and should be followed by Lugol’s iodine test for an optimal yield of LSIL/HSIL. LEEP/LLETZ remains the standard and techniques such as SWETZ, C-LETZ, and TCBEE are not superior. LEEP/LLETZ should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with LSIL, especially in women with HIV infection, but LEEP/LLETZ remains the standard for HSIL. Topical imiquimod remains an experimental procedure. In conclusion, significant progress has been made in the last decade regarding both diagnostic interventions as well as therapeutic interventions for women with cervical dysplasia. Based on >30 controlled clinical trials, we were able to formulate specific and evidence-based recommendations.

Keywords: cervical dysplasia; colposcopy; conization; human papilloma virus.

Figure 1

Flow diagram of the literature search algorithm.

Figure 2

Methodological quality summary (according to the Cochrane Risk of Bias 2 tool [11]): Review authors’ judgements about each methodological quality item for each included study reporting on a randomized controlled trial (n = 28).

Figure 3

“Risk of bias” graph: Review authors’ judgements about each “Risk of bias” item presented as percentages across all included randomized controlled trials (n = 28). See Figure 2 for details.

Figure 4

Methodological quality assessment and scores of prospective, non-randomized trials (n = 5), according to the revised methodological index for non-randomized studies (MINORS; [12]).