Frequency of cervical stenosis and persistent disease following treatment of Squamous Intraepithelial Lesions (SIL) with Loop Electrosurgical Excision Procedure (LEEP) vs cryotherapy.

The objective was to compare the frequency of cervical stenosis and persistence of SIL following LEEP vs cryotherapy. After IRB approval, a retrospective cohort study was conducted via chart review of patients treated for SIL at our tertiary care center from July 1999 until June 2000. Exclusion criteria included atypical squamous cells of undetermined significance on pap (n = 17) or cervical cancer diagnosis (n = 0). Cohorts were assigned based on SIL treatment with LEEP (n = 58, 33.5%) or cryotherapy (n = 115, 66.5%) and severity of SIL as high grade SIL (HGSIL) (n = 62) or low grade SIL (LGSIL) (n = 94) based on pap smear results. Data were evaluated for significance via t-test, [chi square] square, Mantel-Haenszel, method, and Fisher's exact test. Statistical significance was set to P < 0.05; 176 patients were eligible and 173 were included (3 excluded due to missing data) and data were extracted from all charts reviewed. Cervical stenosis had a greater incidence in patients treated with LEEP when compared to cryotherapy (10.3 vs 0%, P < 0.001, RR = 12.25). Residual SIL was not different between LEEP treatment vs cryoablation (30.6 vs 32.2%, P = 0.85 [0.41-2.11]). Also, residual SIL was not different between initial treatment indications of HGSIL vs LGSIL (45.1 vs 30.8%, RR 1.46 [0.97-2.2]). LEEP, but not cryoablation, is associated with cervical stenosis. No difference in persistence of SIL was noted between patients treated with LEEP or cryoablation. Ongoing studies of these procedures are needed to characterize the risks and outcomes of each method.

Atyia Sapp, Christopher Robinson, MD, Paul Underwood, MD, Rina Roginsky, MD, and Michael Armstrong MD. Medical University of South Carolina, Department of Obstetrics and Gynecology, Charleston, SC.