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Treatment of Cervical Intraepithelial Neoplasia Using the Loop Electrosurgical Excision Procedure

From the Division of Obstetrical and Gynecological Pathology, Columbia- Presbyterian Medical Center, New York, New York; the Department of Obstetrics and Gynecology, Chicoutimi Hospital, Chicoutimi, Quebec, Canada; and the Departments of Pathology and Obstetrics and Gynecology, the Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, Quebec, Canada
¹Are consultants to CooperSurgical Company, Shelton, Connecticut

Abstract

In selected patients with cervical intraepithelial neoplasia (CIN), outpatient ablative procedures represent a readily accepted and highly effective treatment modality. The recently introduced loop electrosurgical excision procedure offers a quick and simple alternative to cryotherapy and laser ablation for treating CIN, and has the distinct advantage of allowing both diagnosis and treatment of selected patients at a single visit. This report presents our clinical experience treating 432 patients with CIN using the loop electrosurgical excision procedure on an outpatient basis. Small loop electrodes were used to excise CIN lesions in 275 patients, and large loop electrodes were used in 157. When performed on an outpatient basis under local anesthesia, loop excision was well tolerated by patients with only minimal discomfort. Post-treatment bleeding occurred in less than 2% of the subjects and responded to either recauterization or packing of the cervix. Post-treatment stenosis occurred in less than 1%. The success rate of the loop electrosurgical excision procedure, as defined by absence of cytologic, histologic, or colposcopic lesions 4-48 months after therapy, was 80% for women treated using the small loop electrodes. Ninety percent of all patients treated using the large loop electrodes were free of disease during 6-12 months of follow-up. For women being treated for primary (as opposed to recurrent) disease, the success rate with large loop electrodes was 94%.

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