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Re: CIN 3 in pregnancyFrom: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Thu Aug 26 22:38:15 1999
>Questions >1) Does anybody agree with above? >2) Assuming that she is not pregnant, does anybody think that diathermy >is an adequate treatment? I would have thought that it may not be >adequate as you may not be sure of the depth of the lesion you destroy >and even the extent of it with the concept of field change. Therefore >excision method such as LLETZ would be more appropriate follow up >treatment I presume. Any comments? >3) Finally any place for less extensive treatment for CIN 3 other than >the commonly offered LLETZ or Cone biopsy? If you did the diathermy properly - radical electrocoagulation diathermy with needle and ball - it is the best form of treatment there is - 97% cure rate with long follow-up, can be done as outpatient procedure, uses cheap equipment that everybody has, easy to learn. Would suggest that you repeat colposcopy and cytology after delivery - why did you diathermy anything before you had biopsy back? <1> Unique Identifier 95324123 Authors Chanen W. Institution Royal Women's Hospital, Melbourne, Victoria, Australia. Title Electrocoagulation diathermy. [Review] [25 refs] Source Baillieres Clinical Obstetrics & Gynaecology. 9(1):157-72, 1995 Mar. Abstract With experience extending over an interval of 25 years, one single application of electrocoagulation diathermy has been substantiated as a most consistent and effective method of eradicating precancerous lesions of the cervix. Although there is a protocol for selection that must be adhered to, the vast majority of patients with CIN lesions are suitable for this method of ablative therapy. Ablation by electrocoagulation diathermy appears to have distinct advantages over other methods because of the following: 1. Very high cure rates (98%) with first-time treatment can be achieved, even for major dysplasia and/or carcinoma in situ. 2. Extensive and deep lesions can be effectively eradicated irrespective of the purported histological severity. 3. Electrodiathermy is capable of eradicating lesions extending into the endocervical canal, providing anatomical limits can be evaluated colposcopically. 4. The technique is simple and rapid. The versatility of the electrodes facilitates eradication of the lesion irrespective of the shape and contour of the cervix. 5. No expensive capital outlay nor costly maintenance of equipment is required. 6. There are no physical hazards for medical personnel. 7. It is cost-effective--the technique is readily adaptable as a true out-patient procedure on a 'walk in, walk out' basis. 8. It has a very low incidence of surgical morbidity and does not jeopardize physiological and reproductive function. 9. For practical purposes, the subsequent risk of development of invasive cancer of the cervix can be effectively eliminated. [References: 25] ISSN 0950-3552 <2> Unique Identifier 90104152 Authors Chanen W. Institution Dysplasia and Colposcopy Clinic, Royal Women's Hospital, Melbourne. Title The efficacy of electrocoagulation diathermy performed under local anaesthesia for the eradication of precancerous lesions of the cervix. Source Australian & New Zealand Journal of Obstetrics & Gynaecology. 29(3 Pt 1):189-92, 1989 Aug. Abstract This study demonstrates the feasibility of performing electrocoagulation diathermy with intracervical infiltration of local anaesthetic for precancerous lesions of the cervix. A technique suitable for office procedure without need of any supplementary analgesia is described; 200 patients were treated in this fashion with results indicating the ability to obtain high primary cure rates with low morbidity similar to those previously obtained with general anaesthesia. ISSN 0004-8666 <3> Unique Identifier 83193500 Authors Chanen W. Rome RM. Title Electrocoagulation diathermy for cervical dysplasia and carcinoma in situ: a 15-year survey. Source Obstetrics & Gynecology. 61(6):673-9, 1983 Jun. Abstract The present report assesses 15 years' experience with electrocoagulation diathermy in the treatment of cervical intraepithelial neoplasia (CIN). Selection is based on the ability to visualize the boundaries of the lesion colposcopically. Visualization, together with cytology and target biopsy, should exclude invasive carcinoma. Histologically confirmed CIN of varying severity (almost two thirds were CIN III) was treated by diathermy in 1864 patients. The size of the lesion varied, and at times the lesion extended into the endocervical canal. Cervical intraepithelial neoplasia was eradicated in 97.3% of patients by a single diathermy treatment. Ninety-three percent of all patients under the age of 30 with CIN were treated by this method. Progression to invasive carcinoma after diathermy has not been demonstrated. A single treatment with electrocoagulation diathermy has proved consistently to be the most effective superficial ablative method for primary eradication of CIN whether deep, extensive, or of major severity. ISSN 0029-7844 <4> Unique Identifier 80100153 Authors Chanen W. Title Electrocoagulation diathermy treatment of cervical intraepithelial neoplasia. Source Obstetrical & Gynecological Survey. 34(11):829-30, 1979 Nov. Abstract Although there are other physical methods of destruction which may be effective for small areas of dysplastic change, the author believes that D&C and electrocoagulation diathermy under general anesthesia is a more reliable and more effective method of destruction of abnormal T-Zone. It has the distinct advantage of being able to eliminate large areas, and in particular, changes of major atypia extending into the gland crypts. To date, no patient treated in this fashion has developed invasive carcinoma of the cervix. ISSN 0029-7828
-- Peter Wein
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