Cold coagulation to treat cervical intraepithelial neoplasia



We read with great interest the recent paper on large loop excision of the transformation zone (LLETZ) procedure and preterm delivery.[1] It is astonishing that as a simple, cheap cervical ablative technique with virtually no pregnancy-related morbidity, the Semm cold coagulation has not gained wider acceptance. Twenty years after Ian Duncan's[2] eloquent paper on the efficacy of cold coagulation in treating cervical intraepithelial neoplasia (CIN), very few colposcopy units have adopted the technique. Duncan's primary success rate for treatment of CIN 3 by cold coagulation was 95% at 1 year. A 4-year review of cold coagulation for treating all grades of CIN in our unit found an 89.9% success rate at 1 year.[3] Successful treatment was regarded as a normal colposcopy and negative smear after treatment.

Ever since the seminal paper on LLETZ as a new treatment for CIN,[4] it would appear that commercial forces have determined the path clinicians have taken to treat CIN. Disposable diathermy loops for LLETZ rather than re-usable, autoclavable probes for cold coagulation have been used in abundance. In recent years greater awareness of the impact of the cervical shortening brought about by LLETZ has emerged. Could it be that the obstetric chickens are home to roost?

We would once again advocate more widespread use of cold coagulation in treating CIN in young women.