TREATMENT OPTIONS FOR THE MANAGEMENT OF PREINVASIVE CERVICAL LESIONS
Abstract
Background: To obtain a complete diagnosis of preinvasive cervical lesions, the results of cytology, col- poscopy and histological biopsy are needed. Low-grade lesions (LG-SIL, CIN 1) should be managed conservatively because such lesions can regress. Treatment is suggested if the abnormality persists for 2 years or if the lesion worsens in grade or size. High-grade lesions (HG-SIL, CIN 2 and 3) are managed by different treatment modalities. Ablative modalities include cryocautery, electrocoagulation diathermy and laser ablation. For ablative treat- ment only ectocervical lesions with entirely visible squamocolumnar junction visible are suitable. Small localized lesions of CIN 1 and 2 may be treated by cryocautery or electroco- agulation diathermy. Lesions entering the cervical canal cannot be destroyed with certainty. Laser destroys the tissue by evaporation and coagulation, and is useful if the dysplastic areas extend into the vaginal fornices. Excision modalities including loop diathermy excision, cold-knife conization, laser cone biopsy and hysterectomy provide specimens for histology. Loop diathermy excision is currently the most common treatment modality. Cold-knife conization is performed with a scalpel. The cone can be broad and shallow or narrow and deep, depending on the location and the size of the lesion. Laser cone biopsy is relatively costly and time-consuming. Histopathology aims to assess the nature of the lesion and to determine whether it has been removed completely.
Conclusions: Treatment of preinvasive lesions is not completely harmless for the patient. Complications include hemorrhage, cervical stenosis or incomplete excision. Hysterectomy should be con- sidered for a patient with CIN suffering from menorrhagia, uterine prolapse or leiomyomas as well as in cases of adenocarcinoma in situ, when the reproductive function has been completed.
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