Cold coagulation to treat cervical intraepithelial neoplasia


Author's Reply


Thank you for allowing us to respond to this letter.[1] We would agree with the authors that cold coagulation is a valid treatment for some women with cervical intraepithelial neoplasia. We are not sure what relevance this has to the findings in our study. It does however allow us to make the point that destructive methods should be used in women who satisfy specific criteria and that the risk of premature labour is likely to be confined to women who have large excisions (e.g. type 3 excisions, suspicion of microinvasive disease, glandular disease and women who have had previous treatment). Several publications referenced in our publication and indeed the findings in our study would suggest that women at particular risk of premature labour after excision are those in whom a large type 2 or type 3 transformation zone excision was necessary. Perhaps it is time for a large randomised controlled trial of cold coagulation versus large loop excision of the transformation zone for women with small type 1 transformation zones?