Abstract
ABSTRACTOBJECTIVESTo determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia.METHODSSystematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018.RESULTSThe total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30–0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16–2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08–1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40–0.59, p ≤ 0.001).CONCLUSIONSThe treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.
Highlights
Cervical cancer is the fourth most common type of cancer and the fourth leading cause of death in women worldwide[1]
The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease
Cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections
Summary
Cervical cancer is the fourth most common type of cancer and the fourth leading cause of death in women worldwide[1]. Cervical cancer still ranks as the second leading cause of death and the second most common cancer in the female population in low and middle income countries[1]. Cervical intraepithelial neoplasia (CIN) is a premalignant lesion of cervical cancer, histologically divided as CIN1, CIN2 and CIN3. Both these premalignant lesions and cancer in situ are attributed to human papillomavirus (HPV)[2,3]. Monitoring of CIN2 and CIN3 histological lesions becomes a fundamental task in public health given that 31.0% of these evolve into cancer in the following 30 years[5]. Some authors have shown in monitoring cohorts of 10–20 years that the post-treatment rate of premalignant lesions decreases more than 30.0% during the first 10 years[6,7]
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