Efficacy of Loop Electrosurgical Excision Procedure in the Management of Cervical Intraepithelial Neoplasia (CIN) –in A Tertiary Level Hospital

Abstract

Background: Cervical intraepithelial neoplasia (CIN) is the potentially premalignant transformation and abnormal growth of surface epithelial cells of the cervix. CIN is a precancerous condition and curable. Loop electrosurgical excision procedure (LEEP) is a simple, outpatient procedure of removing the transformation zone of cervix. The aim of our study was to evaluate the efficacy of large loop electrosurgical excision procedure (LEEP) as a treatment procedure for cervical intraepiethelial neoplasia. Methods: This prospective observational study was conducted at Colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from June, 2017 to May, 2019. All consecutive patients having colposcopicaly and histopathologicaly proven high grade lesion by colposcopy directed punch biopsy were included in this study. All eligible patients with high grade lesion were underwent LEEP and followed up on 15 days post-procedure, 6 months, 12 months with colposcopy. Results: Sixty (60) cases were undergone LEEP, among them 48 (80%) cases were diagnosed as CIN2 and 12 (20%) cases were CIN3 by colposcopy- directed biopsy. One patient (1.7%) needed hospital admission to controll intra-operative bleeding and in postoperative period 7 (11.7%) patients had mild to moderate post-operative bleeding which was controlled well after application of morsel’s pastes and electro-cautery, one patient (1.7%) had pelvic infection. On 6 months follow-up, in case of CIN2 patients, cure rate was 93.5% (43 of 46) and 1 (2.2%) patient had persistent CIN-2. Patient with persistent CIN2 had re-excision and followed up at 12 month with colposcopy. Among case of CIN-3, the cure rate was 81.8% (9 of 11) and 1 (9.1%) case had CIN2. P-value was 0.244, which was not statistically significant. Overall cure rate on 6 month follow-up was 91.2%. On 12 months follow-up cure rate for CIN2 was 97.8% and for CIN3 was 90.9%. Overall cure rate was 96.5%. P-value was 0.352, which was not statistically significant. Conclusion: Loop electrosurgical excision procedure (LEEP) has a good outcome as a diagnostic and treatment procedure for cervical intraepithelial neoplasia. Bangladesh Medical Res Counc Bull 2023; 49(2): 113-119