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BMJ. Jun 30, 1990; 300(6741): 1690–1693.
PMCID: PMC1663301

Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.


OBJECTIVE--To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. DESIGN--Prospective programme trial with six month follow up. SETTING--Two hospital based colposcopy clinics. PATIENTS--616 Patients aged 16-60 with abnormal cervical smears. INTERVENTIONS--After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. MAIN OUTCOME MEASURES--Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. RESULTS--Treatment was completed in a mean of 3.47 minutes (SD 1.99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4.4%. CONCLUSION--Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.

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Selected References

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  • Prendiville W, Davies R, Berry PJ. A low voltage diathermy loop for taking cervical biopsies: a qualitative comparison with punch biopsy forceps. Br J Obstet Gynaecol. 1986 Jul;93(7):773–776. [PubMed]
  • Woodman CB, Williams D, Yates M, Tomlinson K, Ward K, Luesley D. Indicators of effective cytological sampling of the uterine cervix. Lancet. 1989 Jul 8;2(8654):88–90. [PubMed]
  • Luesley DM, Jordan JA, Woodman CB, Watson N, Williams DR, Waddell C. A retrospective review of adenocarcinoma-in-situ and glandular atypia of the uterine cervix. Br J Obstet Gynaecol. 1987 Jul;94(7):699–703. [PubMed]
  • Jordan JA, Woodman CB, Mylotte MJ, Emens JM, Williams DR, MacAlary M, Wade-Evans T. The treatment of cervical intraepithelial neoplasia by laser vaporization. Br J Obstet Gynaecol. 1985 Apr;92(4):394–398. [PubMed]

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