Authors:

Redman CWE. Buxton EJ. Cullimore J. Luesley DM.

Institution:

Academic Department of Obstetrics and Gynaecology, Dudley Road Hospital, Birmingham B18 7QH; United Kingdom.

Title:

Gynaecology: Loop diathermy excision of the cervical transformation zone in the management of cervical intraepithelial neoplasia (1990-411).

Source:

Contemporary Reviews in Obstetrics and Gynaecology. Vol 2(1) (pp3-58), 1990.

Abstract:

The aetiology and natural history of cervical intraepithelial neoplasia (CIN) are imperfectly understood. The belief that invasive carcinoma of the cervix may ensue unless CIN is eradicated remains the principal reason for treatment. Although low grade lesions (CIN 1) may behave differently from high grade lesions, treatment encompasses all grades, and will continue to do so until more reliable information about prognosis is available. In addition, there is considerable pressure from the patients themselves for treatment as a result of anxiety resulting from the knowledge that they have an abnormal PAP test (cervical smear). Since the mid-1970s, and even more since the introduction of a national cervical screening programme, there has been a great increase in the number of women requiring diagnosis and treatment because of abnormal PAP test (cervical smear)s. This increased workload has resulted in an increased demand for personnel experienced in the assessment and management of abnormal PAP test (cervical smear)s, and for effective treatments that are cheap, rapid and associated with little morbidity. Many patients are young and nulliparous, so that the preservation of cervical function, particularly future fertility, is an important consideration. Clinicians treating CIN must evaluate outcome not only in terms of disease eradication but also considering the preservation of cervical structure and function. These ideas have radically influenced the management of CIN, reflected by the swing from radical surgical excision to more conservative therapies.


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