Needle versus Loop Diathermy Excision of the Transformation Zone for the Treatment of Cervical Intraepithelial Neoplasia: A Randomized, Controlled Trial

Abstract

This study was conducted to compare the use of loop diathermy excision (LLETZ) with needle excision of the transformation zone (NETZ) in the treatment of cervical intraepithelial neoplasia (CIN). Study subjects were recruited from women undergoing their first cervical treatment for CIN. In LLETZ procedures, excisions were performed using a 1.5-, 1.8-, or 2.2-cm tungsten diathermy loop at diathermy settings specified by the surgeon. For NETZ procedures, a 2-cm long tungsten wire (Rocket) with a coagulation setting of 35 W was used. All procedures were performed by 1 of 12 surgeons, only 3 of whom had experience with needle excision. Four hundred eligible women were randomized to be treated with LLETZ or NETZ. CIN was found in the surgical specimens of 347 subjects. Demographic data were similar for the 2 treatment groups. NETZ procedures were an average 2 minutes longer than LLETZ and more prone to interference from blood loss. Surgeons found NETZ more difficult than LLETZ. Three women in the NETZ group required a vaginal pack to control perioperative bleeding. There were no other perioperative complications in either group. Three hundred fifty-two women returned for at least 1 follow-up appointment at 6 or 12 months. The incidence of genital infection, postoperative readmissions to the hospital, blood transfusions, and cervical sutures to control secondary hemorrhage were similar in both groups. Eight percent of the patients who had LLETZ and 13% of the NETZ patients developed cervical stenosis, but the difference was not significant. The surgical specimen had to be removed in more than 1 piece in 59 of the 200 women (39.5%) in the LLETZ group compared with 5 (2.5%) in the NETZ. Cone specimens were deeper in NETZ procedures (20 mm) compared with LLETZ procedures (14 mm) (P <0.001) and larger in volume (3143 mm3) than LLETZ specimens (2404 mm3) (P = 0.033). Seventeen patients who underwent LLETZ (9.7%) had at least 1 unclear margin in the surgical specimen compared with 5 (2.9%) in the NETZ group (P = 0.031). Histologic diagnoses did not differ between groups. Statistical analysis found no bias according to the surgeon performing the procedure.