A. Bar-am et al., Combined colposcopy, loop conization, and laser vaporization reduces recurrent abnormal cytology and residual disease in cervical dysplasia, GYNECOL ONC, 78(1), 2000, pp. 47-51
Objectives. Loop electrosurgical excision of the transformation zone (LEETZ
) was recently associated with relatively high failure rates. We evaluated
whether the combination of LEETZ with laser vaporization is superior to LEE
TZ alone in reducing the rates of recurrent abnormal cytology and residual
disease.
Methods. The study population included 426 women with histologic diagnosis
of cervical intraepithelial neoplasia (CIN) 2-3, of whom 289 (study group)
were treated by LEETZ followed by laser vaporization of the crater base and
walls and 137 (control group) were treated by LEETZ alone. All women were
followed scrupulously at regular intervals for recurrent abnormal cytology
and residual disease. The mean follow-up periods were 43 and 59 months for
the study and control groups, respectively.
Results. Both groups were derived from the same community and were similar
in epidemiologic characteristics and disease severity. Although the inciden
ce of positive surgical margins was similar in both groups (10.4 and 9.5% f
or the study and control groups, respectively), recurrent abnormal cytology
(10.2% vs 5.5%, P = 0.07) and histologic residual disease (21.4% vs 0%, P
= 0.05) were more frequent among women in the control group. This applied t
o women with both negative and positive surgical margins. Both study and co
ntrol women with positive surgical margins, especially at the endocervix, w
ere at higher risk for recurrence.
Conclusion. The addition of laser vaporization to LEETZ may improve outcome
of both women with positive margins and women with negative margins. Our r
esults support conservative management for all treated women, regardless of
cone margin status. (C) 2000 Academic Press.