Abstract
ABSTRACT
The results of treating 317 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) by means of laser ablation have been reviewed. Of the lesions treated, 63 (19.8%) had histological features of atypical condylomas. The method used was vaporization of the entire transformation zone to a depth of 5 to 10 mm by means of carbon dioxide laser. Two hundred thirteen patients had an intracervical block with local anesthetic, 76 patients had no anesthetic, and 28 patients had general anesthesia for a variety of reasons. We found that local anesthetics facilitated treatment.
Cure rates after a single and multiple treatments were 89.2% and 97.8%, respectively. There was no significant difference in cure rate when we compared the group of atypical condylomas with that of CIN without koilocytosis. All of the patients have had between 1 and 3 years of follow-up by colposcopy and cytology. Seventeen patients had biopsyproven residual disease at 4 months follow-up, and 13 others had recurrent disease identified at 1 year follow-up after having been negative at 4 months.
Twenty-six of the 30 patients have been successfully retreated with laser, and 4 have had cone biopsies. No patient treated in our series has subsequently developed an invasive lesion.
We conclude that laser ablation, which is a highly effective treatment for CIN, is equally effective for atypical condylomas. We recommend local anesthesia, and for highly selected cases, general anesthesia is useful. We found recurrence of CIN in 4% of cases which had been negative at 4 months, and we therefore perform colposcopic follow-up for 1 year after a single treatment and for a further 2 years following a repeat treatment.
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