Virological and cytological clearance in laser vaporization and conization for cervical intra-epithelial neoplasia grade 3

• Published in: The journal of obstetrics and gynaecology research Vol. 42; no. 12; pp. 1808 - 1813
• Main Authors: Mariya, Tasuku, Nishikawa, Akira, Sogawa, Kanae, Suzuki, Riri, Saito, Masae, Kawamata, Akari, Shimizu, Ayumi, Nihei, Takehito, Sonoda, Tomoko, Saito, Tsuyoshi
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Cervical cancer; cervical intra-epithelial neoplasia grade 3; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - surgery; Cervical Intraepithelial Neoplasia - virology; Colposcopy; Conization - methods; Disease-Free Survival; Female; Genotype; Gynecologic Surgical Procedures - methods; human papilloma virus; Human papillomavirus; Humans; laser conization; Laser Therapy - methods; laser vaporization; Lasers; Neoplasm Grading; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - virology; Papillomaviridae; Papillomaviridae - genetics; Papillomavirus Infections - complications; Pregnancy; Pregnancy Outcome; Premature birth; Prospective Studies; Risk Factors; Sensitivity and Specificity; Treatment Outcome; human papilloma virus; laser vaporization; cervical intra-epithelial neoplasia grade 3; laser conization
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.13113

Aim Cervical intra‐epithelial neoplasia (CIN) is the precancerous stage of cervical cancer. Standard treatment for high‐grade CIN is conization of the cervix. The risk of preterm birth following conization has been discussed recently. In contrast, laser vaporization is believed not to affect perinatal outcome, but the long‐term effectiveness of each surgical procedure is still unclear. The aim of this prospective unmatched‐cohort study was therefore to compare virological and cytological clearance and recurrence risk between conization and vaporization for CIN3. Methods Subject consisted of CIN3 patients treated at the present hospital between 2007 to 2011 and followed up until December 2014. One hundred and one patients were treated with laser conization, and 137 with vaporization. The surgical procedure was selected on the basis of colposcopy, pathological grade and patient's hope for pregnancy. Results There were no significant differences in cure rate, human papilloma virus (HPV) clearance rate or recurrence rates between the conization and vaporization groups. Risk ratio of recurrence for each surgical procedure adjusted for age and HPV persistence status were analyzed on Cox proportional hazards modeling. Recurrence risk ratio for patients treated by vaporization was 6.21 (95%CI: 0.65–59.19; P = 0.111) compared with conization and there were no significant differences. No adverse pregnancy outcome was observed in the vaporization group compared with conization. Conclusions Laser vaporization is useful for young patients with CIN3 who hope for pregnancy in the future.