×
Home
Archive Submission Guidelines
News Contact
Review article
Crossmark

Controversies in the Choice of the Optimal Therapeutic Approach to High Grade Intraepithelial Lesions (HSIL) of the Cervix

By
Radomir Živadinović ,
Radomir Živadinović
Goran Lilić ,
Goran Lilić
Aleksandra Petrić ,
Aleksandra Petrić
Vekoslav Lilić ,
Vekoslav Lilić
Biljana Đorđević
Biljana Đorđević

Abstract

The incidence of preinvasive changes in the cervix is constantly rising. It is particularly alarming that there is a larger number of younger patients in whom some stage of these changes has been diagnosed or who had already received some type of treatment before. Technological development and improvement of various forms of treatment have lead to changes in the surgical approach to intraepithelial lesions of the cervix. The techniques that have been developed for this purpose, besides the cold-knife conization, include loop excision, radio wave conization, laser conization and, recently, the conization by Harmonic scalpel. The question that inevitably arises is: Has the technological development led to more conservative approaches and improvement in the results of surgical treatment? This paper will try to partly answer this question and initiate some new questions and dilemmas. A comparative review of all of the abovementioned surgical techniques and their detailed analysis is expected to provide at least some answers to the controversial opinions for and against the new surgical procedures. The results of surgical treatments and their complications were analyzed with particular emphasis on the influence that these methods have on fertility. The conclusion is that there is no ideal surgical procedure which could replace and neglect the experience of a colposcopist. New surgical techniques have brought more surgical comfort and faster recovery but have not demonstrated significant change in the final results of treatment and recurrence.

References

1.
Nagar HA, Dobbs SP, McClelland HR, Price JH, MCClean G, MCCluggage WG. The large loop excision of the transformation zone cut or blend thermal artefact study: a randomized controlled trial. International Journal of Gynecological Cancer. 2004;14(6):1108–11.
2.
Stoler MH, Wright TC, Sharma A, Apple R, Gutekunst K, Wright TL. High-Risk Human Papillomavirus Testing in Women With ASC-US Cytology. American Journal of Clinical Pathology. 2011;135(3):468–75.
3.
Hagen B, Skjeldestad F, Bratt H, Tingulstad S, Lie A. CO 2 laser conization for cervical intraepithelial neoplasia grade II-III, complications and efficacy. Acta Obstetricia et Gynecologica Scandinavica. 1998;77(5):558–63.
4.
Krebs HB, Pastore L, Helmkamp BF. Loop electrosurgical excision procedures for cervical dysplasia: Experience in a community hospital. American Journal of Obstetrics and Gynecology. 1993;169(2):289–95.
5.
Penna C, Fambrini M, Fallani MG, Pieralli A, Scarselli G, Marchionni M. Laser CO2 conization in postmenopausal age: risk of cervical stenosis and unsatisfactory follow-up. Gynecologic Oncology. 2005;96(3):771–5.

Citation

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.