Loop diathermy excision of the abnormal cervical transformation zone

Abstract

Six-hundred patients with abnormal cervical transformation zones were treated by loop diathermy excision. The patients were referred to the colposcopy clinic in the Regional Department of Gynaecological Oncology, Gateshead with abnormal cervical cytology. The indications for treatment, management and follow-up are presented. All patients were managed as out-patients under local anesthesia (71%) or as half-day inpatients under short general anesthesia (29%). Patients were treated with loop diathermy excision of visible lesions or with loop diathermy conization as required. Eradication of cervical intra-epithelial neoplasia (CIN) was achieved with one treatment in 95.5% of cases of CIN. The procedure is rapidly and easily performed. Major morbidity is rare. Only two patients required blood transfusion following treatment. Loop diathermy excision is ideally suited to a policy of combined diagnosis and treatment for these patients allowing efficient use of clinic time. The danger of inadvertant local destruction of early invasive disease is minimized. When preliminary colposcopically directed punch-biopsy histology was compared to definitive loop histology, CIN3 was detected in 27.4% of loops where the punch biopsies failed to show CIN and one case of CIN3 on punch biopsy was upgraded to invasive squamous carcinoma on loop biopsy. Loop excision biopsy therefore gives more complete histologic information than traditional punch biopsy. This technique is effective, efficient, economical and highly acceptable to both patient and practitioner. It is now the treatment of choice for management of the abnormal transformation zone in our practice.