Loop Electrosurgical Excision Procedure for Cervical Intra-Epithelial Neoplasia: Experience in the Western Arctic. A Clinical and Economic Assessment

Abstract

Objective: to assess the clinical and economic benefits of loop electrosurgical excision procedure (LEEP) for cervical intra-epithelial neoplasia (CIN) in Western Arctic communities of the Northwest Territories.Design: review of experience with consolidated diagnosis and treatment arrangements for selected women with CIN.Setting: Stanton Regional Hospital, which provides specialist services, and supports primary health care services for Western Arctic communities.Patients: patients with CIN III or CIN II lesions, and those with CIN I lesions greater than one cm in diameter were considered for inclusion in the study. Exclusion criteria were pregnancy, known or apparent cervicitis, extensive lesions covering much of the cervix, and the squamo-columnar junction not visible.Interventions: the bop electrosurgical excision procedure was performed on 127 women. After each procedure, an endocervical curettage (ECC) was performed. Patients were followed for one year after surgery.Outcome measures: persistent and new disease at six and 12 months post-surgery; patient convenience; health system costs.Results: there was less than one percent persistent disease, as evidenced by ECC, and two percent and three percent of new abnormalities at six months and 12 months, respectively, results comparable to those reported elsewhere with conventional treatment.Conclusions: with low incidence of persistent or new CIN following LEEP, it would be advantageous to follow-up at six and 12 months with Pap. smears only for patients with negative loop margin and ECC findings. This would reduce the number of physician visits from three to one, with significant improvement in patient convenience, and reduction in medical travel and associated costs.