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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 4/2017

01-04-2017 | Gynecologic Oncology

Comparison of cure rates in women treated with cold-coagulation versus LLETZ cervical treatment for CIN2-3 on pretreatment cervical punch biopsies: a retrospective cohort study

Authors: Dimitrios Papoutsis, Martyn Underwood, William Parry-Smith, Jane Panikkar

Published in: Archives of Gynecology and Obstetrics | Issue 4/2017

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Abstract

Purpose

To compare the cure rates between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia grade 2 (CIN2) or 3 (CIN3) on pretreatment cervical punch biopsies.

Methods

This was a retrospective cohort study of women having had a single cervical treatment for CIN2 or CIN3 on pretreatment cervical punch biopsies between 2010 and 2011. The cure rates were defined as the absence of any dyskaryosis (mild/moderate/severe) on cytology tests during follow-up and were determined at 6 and 12 months after treatment.

Results

We identified 411 women having had cervical treatment with 178 cases of cold-coagulation and 233 cases of LLETZ. The cure rates at 6 months following cold-coagulation and LLETZ treatment were 91.6 versus 97.1% (p = 0.02), whereas at 12 months, they were 96.5 versus 97.3% (p = 0.76). Multivariable analysis showed that after adjusting for confounding factors, there was a fourfold higher cure rate with LLETZ in comparison with cold-coagulation at 6 months after treatment (adjusted OR 4.50, 95% CI 1.20–16.83; p = 0.026), with this difference disappearing at 12 months. The lower cure rates with cold-coagulation were due to its higher rates of mild dyskaryosis cytology tests at 6 months. The rates of moderate/severe dyskaryosis cytology tests were similar between the two treatment methods at 6 and 12 months.

Conclusion

We found that women with CIN2 or CIN3 on pretreatment cervical punch biopsies, after adjusting for multiple confounding factors, had higher cure rates when treated with LLETZ versus cold-coagulation at 6 months, with this difference disappearing at 12 months.
Literature
1.
Katki HA, Schiffman M, Castle PE, Fetterman B, Poitras NE, Lorey T et al (2013) Five-year risks of CIN 3+ and cervical cancer among women with HPV-positive and HPVnegative high-grade Pap results. J Low Genit Tract Dis 17:S50–S55CrossRefPubMedPubMedCentral
2.
Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD et al (2012) Members of LAST project work groups. The lower anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis 16:205–242CrossRefPubMed
3.
Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO (2013) Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev 4(12):CD001318
4.
McCredie MR, Sharples KJ, Paul C, Baranyai J, Medley G, Jones RW et al (2008) Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol 9:425–434CrossRefPubMed
5.
Kitchener HC, Cruickshank ME, Farmery E (1995) The 1993 British Society for Colposcopy and Cervical Pathology/National Coordinating Network United Kingdom Colposcopy Survey. Comparison with 1988 and the response to introduction of guidelines. Br J Obstet Gynaecol 102:549–552CrossRefPubMed
6.
Prendiville W, Cullimore J, Norman S (1989) Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol 96:1054–1060CrossRefPubMed
7.
Kyrgiou M, Koliopoulos G, Martin-Hirsch P et al (2006) Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and metaanalysis. The Lancet 367:489–498CrossRef
8.
Semm K (1966) New apparatus for the ‘cold-coagulation’ of benign cervical lesions. Am J Obstet Gynecol 95:963–966CrossRefPubMed
9.
O’Dwyer V, Madden M, Hickey K (2013) Cold coagulation to treat cervical intraepithelial neoplasia. BJOG 120:510CrossRefPubMed
10.
Loobuyck HA, Duncan ID (1993) Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years’ experience with a see-and-treat policy. BJOG 100:465–468CrossRef
11.
Paraskevaidis E, Kyrgiou M, Martin-Hirsch P (2007) Have we dismissed ablative treatment too soon in colposcopy practice? BJOG 114:3–4CrossRefPubMed
12.
Duncan ID, McKenzie CA, Wilson SM, Gurram S, Koppala S, Neillie LJ (2007) Have we dismissed ablative treatment too soon in colposcopy practice? BJOG 114:777–778CrossRefPubMed
13.
Dolman L, Sauvaget C, Muwonge R, Sankaranarayanan R (2014) Meta-analysis of the efficacy of cold coagulation as a treatment method for cervical intraepithelial neoplasia: a systematic review. BJOG 121:929–942CrossRefPubMed
14.
Parry-Smith W, Underwood M, De Bellis-Ayres S, Bangs L, Redman CW, Panikkar J (2015) Success rate of cold coagulation for the treatment of cervical intraepithelial neoplasia: a retrospective analysis of a series of cases. J Low Genit Tract Dis 19:17–21CrossRefPubMed
15.
Shanbhag S, Clark H, Timmaraju V, Bhattacharya S, Cruickshank M (2009) Pregnancy outcome after treatment for cervical intraepithelial neoplasia. Obstet Gynecol 114:727–735CrossRefPubMed
16.
Reilly R, Paranjothy S, Beer H, Brooks CJ, Fielder HM, Lyons RA (2012) Birth outcomes following treatment for precancerous changes to the cervix: a population-based record linkage study. BJOG 119:236–244CrossRefPubMed
17.
McCarthy CM, Ramphul M, Madden M, Hickey K (2016) The use and success of cold coagulation for the treatment of high grade squamous cervical intra-epithelial neoplasia: a retrospective review. Eur J Obstet Gynecol Reprod Biol 203:225–228CrossRefPubMed
18.
Kocken M, Helmerhorst TJ, Berkhof J, Louwers JA, Nobbenhuis MA, Bais AG et al (2011) Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study. Lancet Oncol 12:441–450CrossRefPubMed
19.
van Hamont D, van Ham MA, Struik-van der Zanden PH, Keijser KG, Bulten J, Melchers WJ et al (2006) Long-term follow-up after large-loop excision of the transformation zone: Evaluation of 22 years treatment of high-grade cervical intraepithelial neoplasia. Int J Gynecol Cancer 16:615–619CrossRefPubMed
20.
Paraskevaidis E, Jandial L, Mann EM, Fisher PM, Kitchener HC (1991) Pattern of treatment failure following laser for cervical intraepithelial neoplasia: Implications for follow-up protocol. Obstet Gynecol 78:80–83PubMed
21.
Kitchener HC, Walker PG, Nelson L, Hadwin R, Patnick J, Anthony GB et al (2008) HPV testing as an adjunct to cytology in the follow up of women treated for cervical intraepithelial neoplasia. BJOG 115:1001–1007CrossRefPubMed
22.
Soutter WP, de Barros Lopes A, Fletcher A, Monaghan JM, Duncan ID, Paraskevaidis E et al (1997) Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia. The Lancet 349:978–980CrossRef
23.
Massad LS, Einstein MH, Huh WK et al (2013) 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 121:829–846CrossRefPubMed
24.
Discacciati MG, de Souza CA, dʼOtavianno MG et al (2011) Outcome of expectant management of cervical intraepithelial neoplasia grade 2 in women followed for 12 months. Eur J Obstet Gynecol Reprod Biol 155:204–208CrossRefPubMed
25.
Castle PE, Schiffman M, Wheeler CM et al (2009) Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. Obstet Gynecol 113:18–25CrossRefPubMedPubMedCentral
26.
Luesley D, Leeson S (2010) Colposcopy and programme management. Guidelines for the NHS cervical screening programme, 2nd edn. Sheffield, NHSCSP Publication No. 20, England
27.
NHSCSP (2016) Colposcopy and programme management. Guidelines for the NHS cervical screening programme, 3rd edn. NHSCSP Publication No. 20, Sheffield, England, March 2016
28.
Ang C, Mukhopadhyay A, Burnley C, Faulkner K, Cross P, Martin-Hirsch P et al (2011) Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG 118:685–692CrossRefPubMed
29.
Mzarico E, Gómez-Roig MD, Guirado L, Lorente N, Gonzalez-Bosquet E (2015) Relationship between smoking, HPV infection, and risk of Cervical cancer. Eur J Gynaecol Oncol 36:677–680PubMed
30.
Papoutsis D, Underwood M, Parry-Smith W, Panikkar J (2015) Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study. Arch Gynecol Obstet 292:1329–1337CrossRefPubMed
31.
Jensen KE, Schmiedel S, Norrild B, Frederiksen K, Iftner T, Kjaer SK (2013) Parity as a cofactor for high-grade cervical disease among women with persistent human papillomavirus infection: a 13-year follow-up. Br J Cancer 108:234–239CrossRefPubMed
32.
Alvarez R, Helm W, Edwards P, Naumann W, Partridge E, Shingleton H et al (1994) Prospective randomised trial of LLETZ versus laser ablation in patients with cervical intraepithelial neoplasia. Gynecol Oncol 52:175–179CrossRefPubMed
33.
Dey P, Gibbs A, Arnold D, Saleh N, Hirsch P, Woodman C (2002) Loop diathermy excision compared with cervical laser vaporisation for the treatment of intraepithelial neoplasia: a randomised controlled trial. BJOG 109:381–385CrossRefPubMed
34.
Mitchell M, Tortolero-Luna G, Cook E, Whittaker L, Rhodes-Morris H, Silva E (1998) A randomized clinical trial of cryotherapy, laser vaporization and loop electrosurgical excision for the treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol 92:737–744CrossRefPubMed
35.
Chirenje ZM, Rusakaniko S, Akino V, Mlingo M (2001) A randomised clinical trial of loop electrosurgical excision procedure (LEEP) versus cryotherapy in the treatment of cervical intraepithelial neoplasia. J Obstet Gynaecol 21:617–621CrossRefPubMed
36.
Sasieni P, Castanon A, Landy R, Kyrgiou M, Kitchener H, Quigley M et al (2016) Risk of preterm birth following surgical treatment for cervical disease: executive summary of a recent symposium. BJOG 123:1426–1429CrossRefPubMed
37.
Parry-Smith W, Papoutsis D, Parris DL, Panikkar J, Redman C, Underwood M (2016) A national colposcopy survey comparing destructive versus excisional treatment for CIN. Birmingham, United Kingdom: RCOG World Congress, 20–22 June 2016, 2016. Abstract
38.
39.
Morrell S, Qian L (2014) A whole-population profile of HPV testing as a test of cure for high-grade cervical dysplasia in NSW, Australia. J Med Screen 21:151–162CrossRefPubMed
40.
Barker V, Rich E, Papoutsis D, Panikkar J, Underwood M (2016) Cold-coagulation for the treatment of CIN, HPV test of cure success rates. RCOG World Congress, Birmingham, 20–22 June 2016 (Abstract)
Metadata
Title
Comparison of cure rates in women treated with cold-coagulation versus LLETZ cervical treatment for CIN2-3 on pretreatment cervical punch biopsies: a retrospective cohort study
Authors
Dimitrios Papoutsis
Martyn Underwood
William Parry-Smith
Jane Panikkar
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-017-4306-z

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