Treatment of cervical intraepithelial neoplasia in outpatient practice

Background
The treatment of CIN is based on two criteria: colposcopic assessment of the altered area and histological verification – the presence and degree of dysplasia are histological diagnoses.

Objectives
To present some destructive (cryodestruction, CO2 laser vaporisation, radiofrequency ablation) and excisional (LLETZ/SWETZ) treatment techniques for cervical intraepithelial neoplasia (CIN), their selection criteria and application in outpatient practice.

Material and methods
This is a retrospective study over a period of one year, which included 101 patients with histologically verified CIN. The diagnosis was made after targeted biopsy under colposcopic control or through a see-and-treat strategy. The following methods were applied: video colposcopy, CO2 laser vaporisation using video colposcopy, cryodestruction, LLETZ (SWETZ) under video colposcopic control.

Results
Destruction treatment was administered to 46 patients (45.5%). Excision therapy was performed on 55 patients (54.5%). CO2 laser vaporisation was performed on 20 (43.5%) of the patients with destructive treatment, cryodestruction – on 20 (43.5%), and radiofrequency ablation – on 6 (13%) patients. All patients on excision therapy underwent the LLETZ procedure. After a median follow-up of 2.5 years, no high grade squamous intraepithelial lesion (HGSIL) recurrence was observed.

Conclusions
The characteristics of the altered area, the squamous-cylindrical epithelium border and degree of CIN’s are decisive for the choice of treatment method – destruction or excision. The role of colposcopy, in this respect, is essential. CINs are successfully treated in an outpatient setting by destructive (CO2 laser vaporisation, cryodestruction) and excisional methods (LLETZ, SWETZ).