The management of cervical intraepithelial neoplasia: the use of the carbon dioxide laser.

This report concerns the experience of an abnormal Pap smear clinic in treating cervical intraepithelial neoplasia (CIN). The CO2 laser was the primary treatment method in 283 consecutive cases during 1977-1981, which fulfilled the criteria for conservative management. Seven percent of cases were performed in hospital as out-patients; the remainder were performed in the clinic without anesthesia. The location and shape of the defect was individualized in each case to conform to the topography of the cervix. The basic configuration, however, was the same for all cases; a dome-shaped defect with a curved apex and straight sides of at least 6 mm in height. Laser surgery was well tolerated; few post-operative complications arose. The squamocolumnar junction reappeared in each case at the level of the external os, facilitating follow-up. Eleven cases (3.9%) exhibited persistent disease within 3 months of primary treatment. Thereafter no primary laser failures occurred. Follow-up in this series ranged from 18 to 36 months. Failure rates for CIN grades are as follows: CIN I, 1.3%; CIN II, 2.0%; CIN III, 7.3%. No case of persistent disease was of greater severity than was originally diagnosed. Ten of the 11 cases were successfully managed with repeat laser surgery, yielding an overall therapeutic success rate of 99.6%. These data indicate that laser surgery is the most efficacious conservative method for eradicating this disease.