Surgery for cervical intraepithelial neoplasia

Several different techniques are in use for the surgical treatment of cervical intra-epithelial neoplasia (CIN), and this review compares the effects of alternative surgical treatments for CIN. Few trials addressed all or even most of the endpoints of the review. No single surgical technique was identified as superior to treat CIN. Of the commonly used techniques, large loop excision of the transformation zone (LLETZ) appears to yield the best specimen for histopathological assessment. The equipment required for LLETZ is less expensive than that for laser excision and vaporisation, making LLETZ a more favored technique. Outcome as based on detection of residual post-treatment disease is however similar with LLETZ or laser. Cryotherapy appears to be effective treatment for low grade CIN lesions but not for high grade lesions. Cold knife cone biopsy has a place when endocervical glandular disease is suspected, or when early invasive cervical cancer is suspected on cytology but when no visible lesion is noted on the cervix.

The review included all randomized or quasi-randomized trials following a standardized methodology. Many end points were assessed which led to several findings being based on the results from one or two trials only. The major end point, detection of residual post-treatment disease, was addressed in all studies.

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