LONG-TERM FOLLOW-UP OF CERVICAL INTRAEPITHELIAL NEOPLASIA TREATED WITH MINIMAL CONIZATION BY CARBON-DIOXIDE LASER

Background and Objective: Minimal conization with carbon dioxide laser (CO2) for safe diagnosis and treatment of cervical intraepithelial ne oplasia (CIN) 1-3 has been utilized for 15 years. To evaluate the resu lts of 15 years' follow-up. Study Design/Materials and Methods: Clinic al prospective study: 2,903 non-pregnant women whose cervicovaginal sm ear revealed CIN 1-3, confirmed by colposcopy, were referred for minim al conization treatment (LMC). This outpatient free-hand excision is p erformed under local anesthesia with a 60-W continuous laser beam focu sed to a 0.1-mm spot size, giving a power density of 165,000 W/cm(2). Adjuvant cervical curettage is done routinely. Results: Complications after the procedure were insignificant. Histopathological investigatio n revealed invasive carcinoma in 1.2% of the minicones. The primary cu re rate was 96.1%. In the life table analysis of the patients the cumu lative risk of recurrence for all forms of CIN was 0.89% at year 5, 1. 36% at year 10, and 3.02% at year 15. There was no sudden onset carcin oma during the follow-up period. Conclusion: Minimal conization is a s afe, effective treatment for CIN and early forms of microinvasive carc inoma. Invasive carcinoma can be detected early and should be treated without delay. The cumulative risk of developing new CIN is 3.02% at y ear 15 and there is no risk of sudden-onset invasive carcinoma followi ng this procedure. (C) 1997 Wiley-Liss, Inc.