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Surgery for cervical intraepithelial neoplasia
P L Martin-Hirsch1, E Paraskevaidis, H Kitchener
1University Department of Obstetrics and Gynaecology, St Mary's Hospital, Whitworth Park, Manchester, UK, M13 0JH.
Objectives:
Cervical intra-epithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the severity of the disease. The objective of this review was to assess the effects of alternative surgical treatments for cervical intra-epithelial neoplasia.
Search Strategy:
We searched the Cochrane Gynaecological Cancer Group trials register and MEDLINE up to July 1997.
Selection Criteria:
Randomised and quasi-randomised trials of alternative surgical treatments in women with cervical intra-epithelial neoplasia.
Data Collection And Analysis:
Trial quality was assessed and two reviewers abstracted data independently.
Main Results:
Twenty-three trials were included. Seven surgical techniques were tested in various comparisons. No significant difference in eradication of disease was shown, other than between laser ablation and loop excision. This was based on one trial where the quality of randomisation was doubtful. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology. Morbidity was lower than with laser conisation, although all five trials did not provide data for every outcome. There were not enough data to assess the effect on morbidity compared with laser ablation.
Reviewer'S Conclusions:
The evidence suggests that there is no obviously superior surgical technique for treating cervical intra-epithelial neoplasia.