Treating intraepithelial lesions of the uterine cervix by laser CO2. Evaluation of the past, appraisal for the future

Background and objective: Carbon dioxide laser (CO2) has been widely used in the past for the treatment of squamous intraepithelial lesions (SIL) of the uterine cervix. We present our 10-year experience of using this modality while evaluating its current and future use.

Materials and methods: From 1988 to 1998, 3,078 women were treated for an intraepithelial lesion of the uterine cervix (SIL) by laser CO2 either by vaporization or conization. The procedure was performed on an outpatient basis and was well tolerated by the great majority of patients. The mean age of the women treated by vaporization was 27.5 years whereas of those managed by conization, 34.8 years.

Results: From the 3,078 women, 750 (24.4%) underwent laser vaporization and the remaining 2,328 (75.6%), conization of the cervix. Complications were minimal and consisted of intraoperative and postoperative bleeding (0.56%), pelvic infections (0.04%) and cervical stenosis (1.1%). Mean follow-up time was 83 months (range 24-142). Relapsing disease (either persistent or recurrent) was detected in 5.6% of the vaporization and 3.9% of the conization group.

Conclusions: The management of SIL of the uterine cervix by laser CO2 offers excellent success rates with minor complications. The preservation of the anatomical integrity of the cervical tissue offers a better follow-up of these patients and the potential for repeat treatment. Although other treatment modalities are available, we believe that laser CO2 represents an excellent surgical tool for the management of intraepithelial lesions of the uterine cervix.

CO2 laser; Squamous intraepithelial lesions (SIL); Cervix

[1] Coppleson M., Atkinson K. H., Dazympk J. C.: "Cervical squamous and glandular intraepithelial neoplasia: Clinical features and review of management". In: Gynecologic Oncology, M. Coppleson et al. (eds), London, Churchill Livingstone, 2''ed., 1992, 571.

[2] Schiffman M., Bauer H., Hoover R. et al.: "Epidemiologic evidence showing that HPV infection causes most cervical intraepithelial neoplasia". J. Nat. Cancer Inst., 1993, 85, 958.

[3] Bosch F. X., Manos M. M., Munoz N. et al.: "Prevalence of human papillomavirus in cervical cancer: a worldwide perspective". J. Nat. Cancer Inst., 1995, 87, 796.

[4] Diakomanolis E., Stefanidis K., Rodolakis A.: "Natural history of cervical human papillomavirus". Lancet., 2001, 3,358, (9292), 1551.

[5] NCI Workshop: "The 1988 Bethesda System for reporting cervical/ vaginal cytological diagnoses". J.A.M.A., 1989, 262, 931.

[6] Mcindoe W. A.,M cLean M. R., Jones R. W. et al.: "The invasive potential of carcinoma in situ of the cervix". Obstet. Gynecol., 1984, 64, 451.

[7] Ostor A. G.: "Natural history of CIN: A critical review". Int. J. Gynecol. Pathol., 1993, 12, 186.

[8] Graham J. B.,M eigs J. V.: "Recurrence of tumor after total hysterectomy for carcinoma in situ". Am. J. Obstet. Gynecol., 1952, 64, 1159.

[9] Crisp W. E., Asadourian L., Romberger W.: "Application of cryosurgery to gynecologic malignancy". Obstet. Gynecol., 1967, 30, 668.

[10] Chanen W., Hollyock V. E.: "Colposcopy and electrocoagulation diathermy for cervical dysplasia and carcinoma in situ". Obstet. Gynecol., 1971, 37, 623.

[11] Dorsey J. H., Diggs E. S.: "Microsurgical conization of the cervix by carbon dioxide laser". Obstet. Gynecol., 1979, 54, 565.

[12] Prendiville W., Cullimore J., Norman S.: "Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia". Br. J. Obstet. Gynaecol., 1989, 96, 1054.

[13] Basu P. S., D'Arcy T., Mcindoe A., Soutter W. P.: "Is needle diathermy excision of the transformation zone a better treatment for cervical intraepithelial neoplasia than large loop excision?". Lancet., 1999, 353, 1852.

[14] Baggish M. S.: "High power density CO2 laser therapy for early cervical neoplasia". Am. J. Obstet. Gynecol., 1980, 136, 117.

[15] Creasman W. T., Clarke-Pearson D. L., Weed J. C.: "Results of outpatient therapy of cervical intraepithelial neoplasia". Gynecol. Oncol. Suppl., 1981, 12, 306.

[16] BaggishM. S.: "A and laser vaporization for treatment of cervical intraepithelial neoplasia". Am. J. Obstet. Gynecol., 1986, 155, 39.

[17] Jordan J. A., Woodman C. B. J.,M ylotte M. J. et al.: "The treatment of cervical intraepithelial neoplasia by laser vaporization". Br. J. Obstet. Gynaecol., 1985, 92, 394.

[18] Anderson M. C.: "Invasive carcinoma of the cervix followmg local destructive treatment for cervical intraepithelial neoplasia". Br. J. Obstet. Gynaecol., 1993, 100, 657.

[19] Partington C. K., Turner M. J., Soutter W. P. et al.: "Laser vaporization versus laser excision conization in the treatment of cervical intraepithelial neoplasia". Obstet. Gynecol., 1989, 73, 775.

[20] Benedet J. L., Anderson G. H., Boyes D. A.: "Colposcopic accuracy in the diagnosis of microinvasive and occult invasive carcinoma of the cervix". Obstet. Gynecol., 1985, 65, 557.

[21] Kristensen G., Jensen L., Hylund B.: "A randomised trial comparing two methods of cold knife conization with laser conization". Obstet. Gynecol., 1990, 76, 1009.

[22] Abdul-Karim F., Nunez C.: "Cervical intraepithelial neoplasia after conization: A study of 522 consecutive cones". Obstet. Gynecol., 1985, 65, 77.

[23] Larsson G.: "Conization for preinvasive and early invasive carcinoma of the uterine cervix". Acta Obstet. Gynecol. Scand. Suppl., 1983, 114, 1.

[24] Claman A. D., Lee M.: "Factors that relate to complications of cone biopsy". Am. J. Obstet. Gynecol., 1974, 120, 124.

[25] Davis R. M., Cooke J. K., Kirk R. F.: "Cervical conization. An experience with 400 patients". Obstet. Gynecol., 1972, 40, 23.

[26] Larsson G., Gullberg B. 0., Grundsell H.: "A comparison of complications of laser and cold knife conization". Obstet. Gynecol., 1983, 62, 213.

[27] Bostofte E., Berget A., Larsen J. F.: "Conization by carbon dioxide laser or cold knife in the treatment of cervical intraepithelial neoplasia". Acta Obstet. Gynecol. Scand., 1986, 65, 199.

[28] Paraskevaidis E., Jandial L.,M ann E.M.F. et al.: "Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol". Obstet. Gynecol., 1991, 78, 80.

[29] Flannelly G., Langhan H., Jandial L. et al.: "A study of treatment failures following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia". Br. J. Obstet. Gynaecol., 1997, 104, 718.

[30] Widrich T., Kennedy A. W., Myers T. M. et al.: "Adenocarcinoma in situ of the uterine cervix: management and outcome". Gynecol. Oneal., 1996, 61, 304.

[31] Kennedy A. W., Gama! H. E., Biscotti C. V., Wirth S.: "Invasive adenocarcinoma of the cervix following LLETZ for adenocarcinoma in situ". Gynecol. Oneal., 1995, 58, 274.

[32] Hammond R., Edmonds D. K.: "Does treatment for cervical intraepithelial neoplasia affect fertility and pregnancy?". Br. Med. J., 1990, 301, 1344.

[33] Montz F. J.: "Impact of therapy for cervical intraepithelial neoplasia on fertility". Am. J. Obstet. Gynecol., 1996, 175, 1129.

[34] F owler J.M., Davos I., Leuchter R. S. et al.: "Effect of CO2 laser conization of the uterine cervix on pathologic interpretation of cervical intraepithelial neoplasia". Obstet. Gynecol., 1992, 79, 693.

[35] Baggish M. S., Dorsey J. H., Adelson M.: "A ten-year experience treating intraepithelial neoplasia with the CO, laser". Am. J. Obstet. Gynecol., 1989, 161, 60.

[36] Montz F. J.: "Management of high-grade cervical intraepithelial neoplasia and low-grade squamous intraepithelial lesions and potential complications". Clin. Obstet. Gynecol., 2000, 43, 394.

[37] Paraskevaidis E., Lolis E. D., Koliopoulos G. et al.: "Cervical intraepithelial neoplasia outcomes after large loop excision with clear margins". Obstet. Gynecol., 2000, 95, 828.