Management of cervical intraepithelial neoplasia

Three outpatient therapies--cryotherapy, laser vaporization, and loop electrosurgical excision procedure (LEEP)--are used in the US for the treatment of cervical intraepithelial neoplasia (CIN). There has been considerable controversy, however, about the relative safety, efficacy, and costs of these methods. A rigorous study (Mitchell et al.) in which patients were stratified by key prognostic variables provided irrefutable evidence of the similarity of efficacy of the three methods. This suggests that only cost and concern over the small risk of missing adenocarcinoma-in-situ or microinvasive cancer need influence decisions about CIN treatment. Women with lesions affecting more than two-thirds of the surface of the cervix are more than 19 times more likely to have persistent disease than women with smaller lesions, regardless of therapy type. The amount of tissue removed by laser, cryotherapy, and LEEP is small, so these techniques have no adverse affect on pregnancy. The issue of whether low-grade lesions should be treated, even though most are self-limiting, continues to be debated.