ONE-SESSION MANAGEMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA - A SOLUTION FOR DEVELOPING-COUNTRIES - A PROSPECTIVE, RANDOMIZED TRIAL OF LEEP VERSUS LASER EXCISIONAL CONIZATION

Six hundred thirty-nine patients with CIN on referral Pap were evaluat ed cytocolposcopically at the first visit and decided whether to be tr eated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in fi ve of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two h undred ninety-four patients (46%) were randomly allocated in LEEP (149 ) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen, LEEP was faster and pr oduced less bleeding than laser, although required a mean of four slic es to remove the lesion, Arterial hypertension after anesthetic infilt ration was detected in 26% of cases. Two intraoperative and two delaye d bleeders required surgery. The size of lesion and surgical defect we re larger than those reported in the literature, Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEE P and 3.4% (5/145) with excisional laser had persistent or recurrent C IN on follow-up. Factors predisposing to failure included depth of sur gical defect, grade of lesion, and operator's expertise, With this app roach, 69% of patients referred for cytology of CIN were adequately ma naged in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunct ion with adequate screening is recommended for developing countries. ( C) 1996 Academic Press, Inc.