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Int J Gynaecol Obstet. 2016 Mar;132(3):266-71. doi: 10.1016/j.ijgo.2015.07.026. Epub 2015 Nov 28.

Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia.

Author information

1
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
2
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Departments of Internal Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, USA.
3
Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
4
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
5
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
6
Faculty of Medicine, University of Science and Technology, Irbid, Jordan.
7
Department of Clinical Epidemiology, 2nd Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
8
Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
9
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: holger.schunemann@mcmaster.ca.

Abstract

BACKGROUND:

Cervical intraepithelial neoplasia (CIN) stage 2-3 is a premalignant lesion that can progress to cervical cancer in 10-20 years if untreated.

OBJECTIVES:

To conduct systematic reviews of randomized and nonrandomized studies for effects of cryotherapy, loop electrosurgical excision procedure (LEEP), and cold knife conization (CKC) as treatment for CIN 2-3.

SEARCH STRATEGY:

Medline, Embase, and other databases were searched to February 2012 for benefits, and to July 2012 for harms. Additionally, experts were contacted. Keywords for CIN, cervical cancer, and the treatments were used.

SELECTION CRITERIA:

Studies of nonpregnant women 18 years or older not previously treated for CIN were included.

DATA COLLECTION AND ANALYSIS:

Two investigators independently screened and collected data. Relative risks and proportions were calculated and evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

MAIN RESULTS:

Recurrence rate was 5.3% 12 months after cryotherapy or LEEP, and 1.4% after CKC. There seemed to be little or no differences in frequency of complications after LEEP or cryotherapy, but they occurred more often after CKC. Evidence suggests premature delivery is most common with CKC, but it also occurs after LEEP and cryotherapy.

CONCLUSIONS:

Despite a comprehensive search, there is very low quality evidence and often no evidence for important outcomes, including reproductive outcomes and complications. Studies assessing these outcomes are needed.

KEYWORDS:

Cervical intraepithelial neoplasia; Cold knife conization; Cryotherapy; Loop electrical excision procedure; Meta-analysis; Review; Uterine cervical neoplasms

PMID:
26643302
DOI:
10.1016/j.ijgo.2015.07.026
[Indexed for MEDLINE]
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