title: Treatment of cervical intraepithelial neoplasia in a prospective study comparing large-loop excision of the transformation zone, laser vaporization, and knife cone biopsy.
abstract: OBJECTIVE
  Our aim was to compare cervical intraepithelial neoplasia (CIN) treatment results in the use of large-loop excision of the transformation zone (LLETZ), laser vaporization, and cold-knife cone biopsy.
  
  
  METHODS
  We included in the study patients with CIN lesions diagnosed at the Hospital Universitario Materno-Infantil Vall d'Hebron and Hospital Clinic i Provincial de Barcelona, Barcelona, Spain, between March 1991 and March 1994. Patients with unsatisfactory colposcopy were excluded from the study. One hundred twenty-three patients were included in this study: 98 patients were compared for LLETZ treatment versus laser vaporization, and 69 CIN3 patients were compared for three treatments: LLETZ, laser vaporization, and knife cone biopsy. Patients were followed at 3-month intervals for at least 1 year. Follow-up included physical examination, cervical Papanicolaou (Pap) smear, cervical colposcopy, and a colposcopically guided biopsy when required. Treatment failure (persistence or recurrence) was defined by the presence of CIN confirmed histologically by a colposcopically guided biopsy.
  
  
  RESULTS
  The mean age of patients was 34.1 years. The agreement between histology from the colposcopically guided biopsy and the surgical specimen was 60%, and the kappa coefficient was 40.7% (moderate agreement). Three cases of microinvasive carcinoma were diagnosed in patients whose initial diagnosis was CIN3 on colpobiopsy (4% of invasion in the initial CIN3 group of patients). In a comparison of LLETZ with laser treatment for all CIN grades, the unique independent prognostic factor for persistence-recurrence of the disease was the colposcopic size of the primary lesion (relative risk, 4.9; Cl, 1.33-18.45).
  
  
  CONCLUSIONS
  We conclude that the LLETZ procedure for CIN treatment demonstrates an advantage over destructive methods for detection of occult microinvasive and invasive cancer. This process is a simple outpatient technique with the same failure as that of laser vaporization in all CIN grades. In the treatment of CIN3, cold-knife cone biopsy had better cure rates. Close follow-up is required in these patients, because of their risk of developing recurrent CIN or invasive carcinoma.
authors.affiliation: *Department of Gynecologic Surgery-Gynecologic Oncology, Hospital Universitario Materno-Infantil Vall d'Hebron †Department of Epidemiology and Statistics, Hospitals de la Vall d'Hebron, Barcelona ‡Department of Gynecologic Surgery-Gynecologic Oncology, Hospital Clinic i Provincial de Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: González-Bosquet
authors.forename: C
authors.initials: C
authors.lastname: Centeno
authors.forename: B
authors.initials: B
authors.lastname: Bermejo
authors.forename: P
authors.initials: P
authors.lastname: Jou
authors.forename: L M
authors.initials: LM
authors.lastname: Puig-Tintoré
authors.forename: J
authors.initials: J
authors.lastname: Xercavins
authors.forename: J
authors.initials: J
authors.lastname: González-Merlo