title: Needle versus loop diathermy excision of the transformation zone for the treatment of cervical intraepithelial neoplasia: a randomised controlled trial.
abstract: OBJECTIVE
  To determine whether lower rates or incomplete resection of cervical intraepithelial neoplasia (CIN) may be achieved by needle excision of the transformation zone (NETZ) than with loop excision (LLETZ).
  
  
  METHODS
  A prospective randomised controlled trial.
  
  
  METHODS
  A gynaecological oncology centre and a teaching hospital in West London.
  
  
  METHODS
  Four hundred and four women due to receive treatment for suspected CIN.
  
  
  METHODS
  Women were randomised to receive either LLETZ or NETZ.
  
  
  METHODS
  The study was designed to demostrate a difference in the proportion of women with clear histological margins of 82% for LLETZ compared to 94% for NETZ with 90% power at a 5% significance level, allowing for absence of CIN in the treatment specimen in 15%.
  
  
  RESULTS
  Four randomised women were excluded from the analysis, as they were ineligible for the study. Three hundred and forty-seven (87%) had CIN in the treatment specimen and could be included in the analysis of excision margins. More women in the NETZ arm had clear histological margins (84.8%vs 75%, (P= 0.03). The median volume of specimens in the NETZ arm was 739 mm(3) larger (P= 0.33) and they were less likely to be removed in multiple pieces (2.5%vs 29.5%, RR 0.09, 95% CI 0.04 to 0.20). Needle excision took longer to perform (median treatment time 210 vs 90 seconds, P<0.0001) and surgeons more often reported the procedure as 'difficult' (9.5%vs 3.0%, RR = 3.17%, 95% CI 1.33 to 7.58). No difference in peri-operative or post-operative complication rates could be demonstrated between the two groups.
  
  
  CONCLUSIONS
  NETZ is more likely to produce a specimen in one piece and with clear margins compared to LLETZ.
authors.affiliation: Gynaecological Oncology Centre, Hammersmith Hospital, London, UK.
authors.forename: Theo
authors.initials: T
authors.lastname: Panoskaltsis
authors.forename: Thomas Edward James
authors.initials: TE
authors.lastname: Ind
authors.forename: Karen
authors.initials: K
authors.lastname: Perryman
authors.forename: Roberto
authors.initials: R
authors.lastname: Dina
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Abrahams
authors.forename: W Patrick
authors.initials: WP
authors.lastname: Soutter
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000379:methods; D003972:Diathermy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009339:Needles; D010298:Parity; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000601:surgery*