title: Comparison of loop electrosurgical conization with one or two passes in high-grade cervical intraepithelial neoplasias.
abstract: The use of loop electrosurgical conization (LEC) for the treatment of large high-grade cervical intraepithelial neoplasias (CINs) is often associated with a difficult procedure that results in accidental sample fragmentation, thermal damage and sometimes the presence of positive margins. This study aims to compare LEC that removes the cervical cone in two blocks (anterior and posterior cervical lips - LEC2) with LEC performed with one pass of the loop (LEC1). In a randomized, controlled trial, patients that needed conization due to high-grade CIN were assigned to one of the techniques. There were no differences in terms of age, cone histopathological diagnosis, blood loss, vaginal injuries, stenosis of the cervical os and specimen artifacts. LEC2 required less hemostatic sutures. LEC2 showed no specimen fragmentation, while LEC1 did (0 vs. 5.9%; p = 0.10). As expected, LEC2 samples were heavier (p = 0.01), included a larger ectocervical area (p = 0.001) and, therefore, had a greater volume (p < 0.001) compared to LEC1 samples. The height of the LEC2 specimens was smaller than that of LEC1 specimens (p < 0.001). LEC2 yielded fewer cases of positive margins (12.7%) than LEC1 (33.3%; p = 0.021). We conclude that the LEC2 technique is an effective treatment choice: it is safe for the patient, with better outcomes regarding sample quality than LEC1. Further studies are encouraged regarding this procedure.
authors.affiliation: Postgraduate Program in Medicine, Medical Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. waldemar.rivoire@gmail.com
authors.forename: Waldemar Augusto
authors.initials: WA
authors.lastname: Rivoire
authors.forename: Heleusa Ione
authors.initials: HI
authors.lastname: Monego
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dos Reis
authors.forename: Márcia Appel
authors.initials: MA
authors.lastname: Binda
authors.forename: Valentino
authors.initials: V
authors.lastname: Magno
authors.forename: Eduardo Belmonte
authors.initials: EB
authors.lastname: Tavares
authors.forename: Luciano Serpa
authors.initials: LS
authors.lastname: Hammes
authors.forename: Edison
authors.initials: E
authors.lastname: Capp
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Edelweiss
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002584:Cervix Uteri; D019092:Conization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D013537:Sutures; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*