Treatment outcomes for squamous intraepithelial lesions

Objective: To assess the effectiveness of cone biopsy, cryotherapy, laser a blation and the loop electrosurgical procedure in the treatment of squamous intraepithelial lesions. Method: Systematic review of randomized controlle d trials in subjects who underwent treatment of low- and high-grade squamou s intraepithelial lesions with these modalities. Main outcome measures incl uded the following: percent resolution and persistence of a lesion and nota ble complications for each procedure. Result: Pooled rates of resolution fo r low-grade, high-grade, or combined squamous intraepithelial lesions were similar across the different treatment modalities (range 85.2-94.7%), with substantial overlap among the 95% confidence intervals. Significant hemorrh age occurred most frequently in subjects who received cone biopsy (4.6%) (9 5% CI: 2.15, 6.99), followed by laser ablation (1.75%) (95% CI: 0.70, 2.81) , and LEEP (1.35%) (95% CI: 0.24, 2.47). No hemorrhages were reported among subjects who received cryotherapy. Study sample sizes were relatively smal l. There were no reported cases of progression to invasive cancer, but dura tion of follow-up (median follow-up time for all eligible studies = 12 mont hs) was not sufficient to evaluate long-term outcomes. Conclusions: There w ere no substantive differences in outcomes regarding persistence and resolu tion in the treatment of squamous intraepithelial lesions for subjects rece iving cone biopsy, cryotherapy, laser ablation, or LEEP. (C) 2000 Internati onal Federation of Gynecology and Obstetrics.