POTENTIAL OF CERVICAL ELECTROSURGICAL EXCISION PROCEDURE FOR DIAGNOSIS AND TREATMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA

The aim of this study was to evaluate the diagnostic potential, treatm ent efficacy, specimen adequacy, and acute complication rate associate d with electrosurgical excision procedure (EEP) of the cervix for the management of cervical intraepithelial neoplasia (GIN). Analysis was p erformed retrospectively on 153 consecutive patients who underwent EEP under colposcopic guidance. Patients with negative endocervical curet tage (ECC), adequate colposcopy, and biopsy-proven CIN were considered candidates for therapeutic EEP, whereas patients with a positive ECC, inadequate colposcopy, or cytology two or more grades discordant from the biopsy results underwent diagnostic EEP. Histopathologic specimen s were graded as adequate, suboptimal, or inadequate. Diagnostic EEP w as performed in 85 cases, and the remaining 68 procedures were perform ed primarily for treatment. Specimens were graded as adequate in 83%, suboptimal in 13%, and inadequate in 4% of the diagnostic EEP's. Speci men adequacy correlated most strongly with operator experience (P < 0. 05). Four patients were found to have microinvasive or invasive cervic al carcinoma. Complications occurred in 7% of the EEPs performed. Most consisted of immediate or delayed hemorrhage. In conclusion, EEP is a safe, well-tolerated procedure which is acceptable as both a therapeu tic and diagnostic tool in the management of CIN when performed by an experienced operator. We recommend that initial EEP procedures should be performed for therapeutic indications, since adequacy of EEP specim ens correlated with the level of operator experience. (C) 1995 Academi c Press, Inc.