Treatment of cervical precancers: back to basics
#MMPMID24807323
Khan MJ
; Smith-McCune KK
Obstet Gynecol
2014[Jun]; 123
(6
): 1339-1343
PMID24807323
show ga
Both ablative (cervical cryotherapy, laser ablation) and excisional methods (loop
electrosurgical excision procedure, cold knife conization) can be effective at
treating cervical precancer. Excisional procedures are associated with adverse
obstetric outcomes including preterm delivery and perinatal mortality with the
depth of excision potentially contributing to the adverse outcomes. Ablative
therapies are now used much less commonly than loop electrosurgical excision
procedure but have less of an effect on adverse obstetric outcomes and hence are
effective alternatives for treating cervical precancer in reproductive-aged
women. Morphometric data indicate that the vast majority of precancerous lesions
are less than 5 mm deep, suggesting that treatments that reach 6-7 mm below the
epithelium are adequate in women with satisfactory colposcopy. Cone biopsies,
"top-hat" loop electrosurgical excision procedures, or the use of loop electrodes
greater than 10 mm are therefore unnecessary for the majority of
reproductive-aged women and increase risk of adverse obstetric outcomes. New
consensus guidelines allow observation instead of treatment in appropriately
selected young women. Until the association of excisional methods with adverse
obstetric outcomes is clarified with more data, ablative methods should be
revitalized and used by health care providers in appropriately selected patients.
Treatment should be individualized based on patient's age, fertility desires, and
colpopathologic findings.
free
free
free
