LOOP ELECTROSURGICAL EXCISION PROCEDURES FOR CERVICAL DYSPLASIA - EXPERIENCE IN A COMMUNITY-HOSPITAL

OBJECTIVE: The study was undertaken to evaluate the use of the loop el ectrosurgical excision procedure as an outpatient hospital or surgicen ter procedure. STUDY DESIGN: The records of 358 patients treated for c ervical intraepithelial neoplasia at a large community hospital over a 1-year period were reviewed. RESULTS: The specimens obtained by loop electrosurgical excision procedure and laser cone excision were compar able in size but smaller than those by means of cold-knife conization. Seventy-two percent of loop electrosurgical excision procedure specim ens consisted of two to eight tissue fragments (mean 3.4). In addition , 48% of the loop electrosurgical excision procedure specimens and 38% of laser cones had moderate or severe thermal artifacts. Fragmentatio n and cautery damage precluded orientation of tissue and evaluation of margins in 19% of the cases. CONCLUSIONS: The advent of the loop elec trosurgical excision procedure has shifted the management of cervical intraepithelial neoplasia from the office to the outpatient surgery ce nters. This negates and, in fact, reverses the advantage of loop elect rosurgical excision procedure over other methods in regard to cost and convenience through evaluating and treating a patient with cervical i ntraepithelial neoplasia in one office visit. Loop electrosurgical exc ision procedures provide specimens that are inferior compared with col d-knife cones; therefore the role of loop electrosurgical excision pro cedure for the management of cervical intraepithelial neoplasia outsid e the office appears limited.