Factors influencing the choice between cold knife conization and loop electrosurgical excisional procedure for the treatment of cervical intraepithelial neoplasia.

摘要

AIM: To determine whether cold knife conization (CKC) or loop electrosurgical excisional procedure (LEEP) is the better option for the treatment of cervical intraepithelial neoplasia (CIN) under specific circumstances. METHODS: We retrospectively reviewed the medical records of patients who underwent CKC or LEEP for the treatment of CIN. The proportion of non-negative surgical margins between the two treatment groups was calculated based on their age, parity, previous mode of delivery, and grade of CIN. The Student's t-test and multivariate logistic regression analysis were used to find the better option for the treatment of CIN under the specific circumstances. RESULTS: A total of 118 patients were enrolled in the study. Between the two treatment groups, there was no significant difference in the overall proportion of non-negative surgical margins (P > 0.05). The grade of CIN, the previous mode of delivery, and parity did not affect the surgical margin status. The CKC treatment group had a significantly lower incidence of non-negative surgical margins than the LEEP treatment group (14.3% vs. 52.6%, respectively; P < 0.05) in the patients >45 years of age. Based on multivariate analyses, LEEP was identified as a significant risk factor for non-negative surgical margins in the patients >45 years of age. Of the 11 patients with non-negative surgical margins who underwent a secondary procedure within 6 months of the initial CKC or LEEP, five patients (45.5%) had residual CIN II and III. CONCLUSIONS: In patients >45 years of age, CKC is the preferred treatment for CIN.