World Health Organization Guidelines: Use of cryotherapy for cervical intraepithelial neoplasia.
BACKGROUND
In 2008, cervical cancer was responsible for 275000 deaths, of which approximately 88% occurred in low- and middle-income countries. In 2009, the World Health Organization (WHO) committed to updating recommendations for use of cryotherapy for cervical intraepithelial neoplasia (CIN).


RESULTS
We followed the WHO Handbook for Guidelines Development to develop present guidelines. An expert panel was established, which included clinicians, researchers, program directors, and methodologists. An independent group conducted systematic reviews and produced evidence summaries following the GRADE approach. GRADE evidence profiles were created for 16 key questions about the effects of cryotherapy in the presence of histologically confirmed CIN compared with no treatment and with loop electrosurgical excision procedure, as well as the use of different cryotherapy techniques. We identified a small number of randomized controlled trials or independently controlled observational studies. Surrogate outcomes were reported when evidence about outcomes critical to decision making were not available. The panel made 14 recommendations and documented factors that determined the strength and direction of the recommendations in decision tables.


CONCLUSIONS
The present document summarizes new evidence-based WHO recommendations about the use of cryotherapy in women with histologically confirmed CIN for low-, middle-, and high-income countries.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Hamilton, Canada.
Nancy
N
Santesso
Holger
H
Schünemann
Paul
P
Blumenthal
Hugo
H
De Vuyst
Julia
J
Gage
Francisco
F
Garcia
Jose
J
Jeronimo
Ricky
R
Lu
Silvana
S
Luciani
Swee C
SC
Quek
Tahany
T
Awad
Nathalie
N
Broutet
D017679:Cryotherapy / Q000379:methods*; D004598:Electrosurgery; D005260:Female; D006801:Humans; D002583:Uterine Cervical Neoplasms / Q000628:therapy*; D014944:World Health Organization; D002578:Uterine Cervical Dysplasia / Q000628:therapy*