ORIGINAL ARTICLE   

Minerva Ginecologica 2018 June;70(3):239-45

DOI: 10.23736/S0026-4784.18.04176-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Age-adjusted treatment of cervical intraepithelial 1 lesions by superficial or regular loop excision of transformation zone

Efraim SIEGLER ^{1, 2}, Lee FUCHS ³, Ofer LAVIE ^{1, 2}, Pninit SAKED-MISAN ⁴, Lena MACHULKI ¹, Yakir SEGEV ^{1, 2} ✉

¹ Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel; ² Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; ³ Department of Orthopedics, Beilinson Medical Center, Petah Tikva, Israel; ⁴ Laboratory of Serology and Virology, Carmel Medical Center, Haifa, Israel

BACKGROUND: The loop electrosurgical excision procedure (LEEP) is one of the treatments for cervical intraepithelial neoplasia 1 (CIN1). One of the risks of LEEP is preterm birth. We evaluated final pathological diagnoses following LEEP as treatment for CIN1 lesions, for procedures in which cone height was determined by patients’ age.
METHODS: A retrospective study of 329 women diagnosed with CIN1 on a cervical biopsy and treated by LEEP. In patients under age 35 years, a thin LEEP COIN was performed, and in women over 35 years, a regular LEEP was performed.
RESULTS: The final pathological diagnosis was CIN2 and CIN3 in 14.6% of the women. The average excision height was 0.64 cm in women aged under 35 years, 0.82 cm in women aged 36-45 years, and 0.96 cm in women older than 46 (P<0.0001). Comparing excision height less than 0.8 cm to excision height above 0.9 cm, complications of the procedure, positive margins rates and recurrence rates were similar.
CONCLUSIONS: Among women of childbearing age, the performance of a LEEP procedure with smaller cone height appeared equivocal in achieving correct pathological diagnoses and low recurrence. To avoid increasing the risk of premature delivery, the excisional depth should be adjusted to age and fertility status.

KEY WORDS: Cervical intraepithelial neoplasia - Electrosurgery - Gynecologic surgical procedures