University of Dundee, Dundee, UK.
Obstetrics and Gynaecology Department, NHS Tayside, Ninewells Hospital, Dundee, UK.
Arch Gynecol Obstet. 2022 Nov;306(5):1815-1820. doi: 10.1007/s00404-022-06409-3. Epub 2022 Feb 2.
Among the treatment modalities for high-grade cervical intraepithelial neoplasia (CIN), large-loop excision of the transformation zone (LLETZ) is the commonest offered in the UK, whereas thermal ablation (TA) has not been common in several decades, despite several notable advantages. TA and LLETZ are both routinely undertaken in our colposcopy unit, and extensive follow-up data have been used to interrogate outcomes between the two modalities and determine whether one modality may be preferred over the other.
Up to 8 years of follow-up data (cytology and histology) were collected for patients who have undergone LLETZ or TA and failed post-treatment test of cure (ToC). These data were analysed and used to plot Kaplan-Meier survival curves, in order to compare outcomes: negative cytology, dyskaryosis, low- and high-grade CIN and invasive squamous cell carcinoma.
i) Very few women treated with TA developed recurrent high-grade CIN in the follow-up period; (ii) LLETZ-treated women had a significantly higher rate of recurrence than those treated by TA; (iii) women who failed both virology and cytology components of post-treatment ToC had higher recurrence than those who failed only one, and the rate of recurrence was highest in those treated by LLETZ (> 65%).
TA is an effective treatment of high-grade CIN, with a high chance of achieving double-negative ToC and low recurrence relative to LLETZ. We recommend the wider adoption of TA, so that young women of reproductive age have a choice of treatment with no reported adverse effects on pregnancy outcomes.
在治疗高级别宫颈上皮内瘤变（CIN）的方法中，英国最常采用的是转化区大环形电切术（LLETZ），而热消融（TA）在过去几十年中并不常见，尽管它有一些显著的优势。TA 和 LLETZ 都是我们阴道镜检查单位常规采用的方法，我们利用广泛的随访数据来探讨两种方法的结果，并确定是否一种方法可能优于另一种。
我们收集了接受 LLETZ 或 TA 治疗但在治疗后转阴测试（ToC）失败的患者长达 8 年的随访数据（细胞学和组织学）。我们对这些数据进行了分析，并使用 Kaplan-Meier 生存曲线进行绘图，以比较两种方法的结果：细胞学阴性、不典型增生、低级别和高级别 CIN 以及浸润性鳞状细胞癌。
i）接受 TA 治疗的女性在随访期间很少出现高级别 CIN 的复发；ii）与接受 TA 治疗的女性相比，接受 LLETZ 治疗的女性复发率明显更高；iii）在接受治疗后 ToC 中同时检测到病毒学和细胞学异常的女性比仅一项异常的女性复发率更高，而在接受 LLETZ 治疗的女性中复发率最高（>65%）。
TA 是治疗高级别 CIN 的有效方法，与 LLETZ 相比，TA 治疗有更高的机会实现双重阴性 ToC，且复发率较低。我们建议更广泛地采用 TA，以便生育年龄的年轻女性有治疗选择，并且不会对妊娠结局产生任何已知的不良影响。
