Cervical intraepithelial neoplasia: Ablative therapies
- Nicholas P Taylor, MD
Nicholas P Taylor, MD
- Section Chief of Gynecologic Oncology
- St. Lukes Hospital
- Temple University
Cervical intraepithelial neoplasia (CIN) is a premalignant cervical disease that is also called cervical dysplasia or cervical squamous intraepithelial lesions (CSIL). (See "Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention", section on 'Terminology'.)
Treatment of CIN can either be excisional (ie, conization) or ablative. Ablative modalities are solely for treatment, while excisional therapy provides diagnostic information as well as therapeutic benefit.
Ablative therapies of the cervix will be discussed in this topic review. In addition, choosing between excision and ablation, as well as between ablative methods will be reviewed. Excisional methods for CIN treatment are discussed elsewhere. (See "Cervical intraepithelial neoplasia: Procedures for cervical conization".)
American Society for Colposcopy and Cervical Pathology guidelines include ablative therapy as an option for women with [1,2]:
●Persistent cervical intraepithelial neoplasia (CIN) 1 for two or more years (excision is preferred if colposcopy is inadequate, endocervical curettage is ungraded or positive for CIN 2,3 , or if previously treated for CIN)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17:S1.
- http://www.asccp.org/ (Accessed on March 22, 2012).
- Schuurmans SN, Ohlke ID, Carmichael JA. Treatment of cervical intraepithelial neoplasia with electrocautery: report of 426 cases. Am J Obstet Gynecol 1984; 148:544.
- Johnson N, Crompton AC. Who finds cervical laser therapy painful? Gynecol Oncol 1994; 52:44.
- Harper DM, Cobb JL. Is it cost-effective to use a mucosal or paracervical block to relieve the pain and cramping from cryosurgery? A decision model. J Fam Pract 1999; 48:285.
- Martin-Hirsch PL, Paraskevaidis E, Kitchener H. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev 2000; :CD001318.
- Abdul-Karim FW, Fu YS, Reagan JW, Wentz WB. Morphometric study of intraepithelial neoplasia of the uterine cervix. Obstet Gynecol 1982; 60:210.
- Hatch KD. Cryotherapy. Baillieres Clin Obstet Gynaecol 1995; 9:133.
- Boonstra H, Koudstaal J, Oosterhuis JW, et al. Analysis of cryolesions in the uterine cervix: application techniques, extension, and failures. Obstet Gynecol 1990; 75:232.
- Stienstra KA, Brewer BE, Franklin LA. A comparison of flat and shallow conical tips for cervical cryotherapy. J Am Board Fam Pract 1999; 12:360.
- Mariategui J, Santos C, Taxa L, et al. Comparison of depth of necrosis achieved by CO2- and N2O-cryotherapy. Int J Gynaecol Obstet 2008; 100:24.
- Creasman WT, Weed JC Jr, Curry SL, et al. Efficacy of cryosurgical treatment of severe cervical intraepithelial neoplasia. Obstet Gynecol 1973; 41:501.
- Duncan ID. Cold coagulation. Baillieres Clin Obstet Gynaecol 1995; 9:145.
- Woodman CB, Jordan JA, Mylotte MJ, et al. The management of cervical intraepithelial neoplasia by coagulation electrodiathermy. Br J Obstet Gynaecol 1985; 92:751.
- Chanen W, Rome RM. Electrocoagulation diathermy for cervical dysplasia and carcinoma in situ: a 15-year survey. Obstet Gynecol 1983; 61:673.
- Giles JA, Walker PG, Chalk PA. Treatment of cervical intraepithelial neoplasia (CIN) by radical electrocoagulation diathermy: 5 years' experience. Br J Obstet Gynaecol 1987; 94:1089.
- Mitchell MF, Tortolero-Luna G, Cook E, et al. A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol 1998; 92:737.
- Kwikkel HJ, Helmerhorst TJ, Bezemer PD, et al. Laser or cryotherapy for cervical intraepithelial neoplasia: a randomized study to compare efficacy and side effects. Gynecol Oncol 1985; 22:23.
- Townsend DE, Richart RM. Cryotherapy and carbon dioxide laser management of cervical intraepithelial neoplasia: a controlled comparison. Obstet Gynecol 1983; 61:75.
- Ferenczy A. Comparison of cryo- and carbon dioxide laser therapy for cervical intraepithelial neoplasia. Obstet Gynecol 1985; 66:793.
- Chew GK, Jandial L, Paraskevaidis E, Kitchener HC. Pattern of CIN recurrence following laser ablation treatment: long-term follow-up. Int J Gynecol Cancer 1999; 9:487.
- Draeby-Kristiansen J, Garsaae M, Bruun M, Hansen K. Ten years after cryosurgical treatment of cervical intraepithelial neoplasia. Am J Obstet Gynecol 1991; 165:43.
- Gordon HK, Duncan ID. Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience. Br J Obstet Gynaecol 1991; 98:14.
- Cirisano FD. Management of pre-invasive disease of the cervix. Semin Surg Oncol 1999; 16:222.
- Hillard PA, Biro FM, Wildey L. Complications of cervical cryotherapy in adolescents. J Reprod Med 1991; 36:711.
- Loobuyck HA, Duncan ID. Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years' experience with a see-and-treat policy. Br J Obstet Gynaecol 1993; 100:465.
- Baggish MS, Dorsey JH, Adelson M. A ten-year experience treating cervical intraepithelial neoplasia with the CO2 laser. Am J Obstet Gynecol 1989; 161:60.
- Schmidt G, Fowler WC Jr. Cervical stenosis following minor gynecologic procedures on DES-exposed women. Obstet Gynecol 1980; 56:333.
- Kalstone C. Cervical stenosis in pregnancy: a complication of cryotherapy in diethylstilbestrol-exposed women. Am J Obstet Gynecol 1992; 166:502.
- Shumsky AG, Stuart GC, Nation J. Carcinoma of the cervix following conservative management of cervical intraepithelial neoplasia. Gynecol Oncol 1994; 53:50.
- Martin-Hirsch PP, Paraskevaidis E, Bryant A, et al. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev 2010; :CD001318.
- Wetchler SJ. Treatment of cervical intraepithelial neoplasia with the CO2 laser: laser versus cryotherapy. A review of effectiveness and cost. Obstet Gynecol Surv 1984; 39:469.
- Kleinberg MJ, Straughn JM Jr, Stringer JS, Partridge EE. A cost-effectiveness analysis of management strategies for cervical intraepithelial neoplasia grades 2 and 3. Am J Obstet Gynecol 2003; 188:1186.
- CANDIDATES FOR ABLATIVE THERAPY
- GENERAL PROCEDURAL ISSUES
- ABLATIVE TECHNIQUES
- CO2 laser
- Cold coagulation
- ADVERSE EFFECTS AND COMPLICATIONS
- Adverse effects
- Late complications
- CHOOSING AN ABLATION TECHNIQUE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS