June 30, 2022

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Cervical precancerous lesions: LEEP circumcision or cold knife conization?

The choice of treatment for cervical precancerous lesions: LEEP circumcision or cold knife conization (CKC)?

 

Cervical precancerous lesions: LEEP circumcision or cold knife conization?  Cervical cancer is a common gynecological malignant tumor, and its incidence ranks second among female malignant tumors.

Cervical cancer is a common gynecological malignant tumor, and its incidence ranks second among female malignant tumors. With the popularization of cervical cancer screening, more and more precancerous lesions of the cervix are detected in time.

 

 

1. What is cervical precancerous lesions?

The occurrence of cervical cancer is a gradual evolution process, which can take from several years to decades. It is generally believed that this evolution process has gone through several stages: mild, moderate and severe dysplasia, carcinoma in situ, and early invasive carcinoma , Invasive cancer, etc.

Cervical precancerous lesions, also known as cervical intraepithelial neoplasia (CIN), include cervical dysplasia and cervical carcinoma in situ. At this stage, the cervical epithelium is overgrowth and there are atypical cells that are different from the normal epithelium.

According to the degree of disease, cervical intraepithelial neoplasia can be divided into CIN I~III grades.

1) Mild (CIN I grade): The lesion is limited to the lower 1/3 of the epithelial layer, that is, mild cervical dysplasia

2) Moderate (CIN Ⅱ grade): The lesion is limited to 1/2 to 2/3 of the epithelial layer, that is, moderate cervical dysplasia

3) Severe (CIN Ⅲ grade): The lesions almost involve all epithelial layers, with only 1-2 layers of normal squamous epithelium remaining, including severe cervical dysplasia and cervical carcinoma in situ

 

According to the latest classification of the World Health Organization (WHO), cervical precancerous lesions are divided into:

Low-grade cervical squamous intraepithelial lesion (LSIL): equivalent to CIN grade I

High-grade cervical squamous intraepithelial lesion (HSIL): equivalent to CIN grade II and CIN grade III

 

 

2. How to deal with cervical precancerous lesions?

Most of the low-grade cervical lesions will subside spontaneously. The treatment mainly adopts conservative methods and regular follow-ups. However, most of the high-grade cervical lesions will further develop into cervical cancer, so timely diagnosis and treatment are needed. Cervical conization surgery is generally used.

note! There are two main purposes for cervical conization:

(1) Therapeutic purpose: to remove the known lesions and have a therapeutic effect;

(2) The purpose of further diagnosis: the surgically removed tissue will be pathologically diagnosed, and the other is to make it clear The degree of lesions; the second is to look at the nature of the margins to determine whether there are residual lesions and deep cervical canal lesions.

 

At present, there are different cervical conization methods such as high-frequency electrosurgical loop electrosurgical excision (LEEP), cold knife conization (CKC), and laser conization.

(1) High-frequency electrosurgical electrosurgical cervical resection (LEEP)

LEEP is a cervical conization operation that uses a “ring” with a high-frequency current to generate heat to remove cervical lesions and high-risk areas (the junction of cervical squamous column epithelium).

The advantages of LEEP are relatively simple operation, short operation time, optional local anesthesia or even no anesthesia. It can also electrocoagulate to stop bleeding while cutting, so there is less bleeding. There are fewer postoperative complications.

Disadvantages: The electrical ring has thermal damage to the removed tissue, which may affect the pathology judgment of the pathologist on the resection margin of the excised specimen.

 

(2) Cervical cold knife conization (CKC)

Cervical cold knife conization is a traditional technique for diagnosing and treating cervical lesions. The so-called cold knife means cutting with a traditional scalpel blade. The scalpel does not generate heat when cutting, so it is called a cold knife.

The advantages of CKC are: the use of a scalpel cone to remove the diseased tissue, and the requirements for surgical equipment are simple. The scalpel blade will not cause thermal damage to the excised specimen, so the pathologist’s judgment on the nature of the specimen’s margin (judging whether there is residual disease) is more accurate.

Disadvantages: relatively more difficult operation, longer operation time, high anesthesia requirements, more bleeding than LEEP, and more postoperative complications. Poor cervical formation is not conducive to follow-up.

 

In short, the two methods have their own advantages, and doctors need to consider comprehensively when making choices.

 

(source:internet, reference only)


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