Surgery for cervical intraepithelial neoplasia

  • Review
  • Intervention

Authors


Abstract

Background

Cervical intra-epithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the severity of the disease.

Objectives

The objective of this review was to assess the effects of alternative surgical treatments for cervical intra-epithelial neoplasia.

Search strategy

We searched the Cochrane Gynaecological Cancer Group trials register and MEDLINE up to July 1997. Update: in July 2004 a further search was conducted.

Selection criteria

Randomised and quasi-randomised trials of alternative surgical treatments in women with cervical intra-epithelial neoplasia.

Data collection and analysis

Trial quality was assessed and two reviewers abstracted data independently.

Main results

Twenty eight trials were included. Seven surgical techniques were tested in various comparisons. No significant difference in eradication of disease was shown, other than between laser ablation and loop excision. This was based on one trial where the quality of randomisation was doubtful. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity. Morbidity was lower than with laser conisation, although all five trials did not provide data for every outcome. There were not enough data to assess the effect on morbidity compared with laser ablation.

Authors' conclusions

The evidence suggests that there is no obviously superior surgical technique for treating cervical intra-epithelial neoplasia.

Plain language summary

Surgery for cervical intraepithelial neoplasia

No clear evidence to show any optimal surgical technique is superior for treating pre-cancerous cervix abnormalities.Cervical pre-cancer (cervical intraepithelial neoplasia) can be treated in different ways depending on the severity of the disease. Less invasive treatments not requiring a hospital stay may be used, but a general anaesthetic is occasionally needed, especially if the tumour has spread locally or previous out-patient treatment has failed. Surgery can be done with a knife, laser or cutting with a loop (an electrically charged wire). This review found there was not enough evidence to compare techniques and that more research is needed.

Ancillary