Vol 94, No 7 (2023)
Research paper
Published online: 2022-06-24

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Clinical efficacy of thermocoagulation in women with biopsy-confirmed cervical low-grade squamous intraepithelial lesions (LSILs) or less after colposcopy referral

Xiaoying Chen1, Jian An2, Jianfang Zhu3
Pubmed: 37602370
Ginekol Pol 2023;94(7):511-517.


Objectives: To evaluate the clinical efficacy of thermocoagulation in women with biopsy-confirmed cervical low-grade squamous intraepithelial lesions (LSIL) or less after colposcopy referral.

Material and methods: A longitudinal study was performed. Women who were diagnosed with cervical LSIL or chronic cervicitis underwent scheduled follow-up examinations with cytology and human papilloma virus (HPV) genotyping for two years after the initial management with thermocoagulation or observation without treatment. All women underwent scheduled follow-up with combined cytology and HPV test at 6th months, 12th months, and 24th months after the initial management. Both HPV clearance and cytological regression were included in the analysis, with clinical cure defined as normal cytology and negative HPV results.

Results: A total of 221 women were included. The histopathological results identified 136 (61.54%) patients with LSIL and 85 (38.46%) with chronic cervicitis. Of these, 113 (51.13%) received thermocoagulation therapy, and 108 (48.87%) chose observation. The 2-year follow-up rate was 91.40%. Women who received thermocoagulation presented a significantly higher probability of cure for two years than those who chose observation (62.86% vs 39.18%, p < 0.001). This preponderance was not observed in the subgroup analysis regarding women with cervical cervicitis (54.17% vs 41.38%, p = 0.277) but was observed in women with LSILs (70.18% vs 38.24%, p < 0.001).

Conclusions: Thermocoagulation may be indicated for patients with cervical LSILs as an effective outpatient procedure in clinical practice.

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  1. Massad LS, Einstein MH, Huh WK, et al. 2012 ASCCP Consensus Guidelines Conference, 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S1–S27.
  2. Bentley J, Bentley J, Bertrand M, et al. Colposcopic Management of Abnormal Cervical Cytology and Histology. Journal of Obstetrics and Gynaecology Canada. 2012; 34(12): 1188–1202.
  3. Nash JD, Burke TW, Hoskins WJ. Biologic course of cervical human papillomavirus infection. Obstet Gynecol. 1987; 69(2): 160–162.
  4. Nasiell K, Roger V, Nasiell M. Behavior of mild cervical dysplasia during long-term follow-up. Obstet Gynecol. 1986; 67(5): 665–669.
  5. K Sy, Kataja V, Yliskoski M, et al. Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda System. Obstet Gynecol. 1992; 79(Pt 1): 675–682.
  6. Cho HW, Kim SY, Lee YJ, et al. Doctor and patient awareness of treatment options for cervical intraepithelial neoplasia 1 (CIN 1): a survey questionnaire approach. J Obstet Gynaecol. 2020; 40(2): 211–216.
  7. Ciavattini A, Clemente N, Tsiroglou D, et al. Follow up in women with biopsy diagnosis of cervical low-grade squamous intraepithelial lesion (LSIL): how long should it be? Arch Gynecol Obstet. 2017; 295(4): 997–1003.
  8. Gordon HK, Duncan ID. Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience. Br J Obstet Gynaecol. 1991; 98(1): 14–20.
  9. Parry-Smith W, Underwood M, De Bellis-Ayres S, et al. Success rate of cold coagulation for the treatment of cervical intraepithelial neoplasia: a retrospective analysis of a series of cases. J Low Genit Tract Dis. 2015; 19(1): 17–21.
  10. Pinder LF, Parham GP, Basu P, et al. Thermal ablation versus cryotherapy or loop excision to treat women positive for cervical precancer on visual inspection with acetic acid test: pilot phase of a randomised controlled trial. Lancet Oncol. 2020; 21(1): 175–184.
  11. Semm K. New apparatus for the "cold-coagulation" of benign cervical lesions. Am J Obstet Gynecol. 1966; 95(7): 963–966.
  12. Cremer ML, Conzuelo-Rodriguez G, Cherniak W, et al. Ablative Therapies for Cervical Intraepithelial Neoplasia in Low-Resource Settings: Findings and Key Questions. J Glob Oncol. 2018; 4: 1–10.
  13. Heideman DAM, Hesselink AT, Berkhof J, et al. Clinical validation of the cobas 4800 HPV test for cervical screening purposes. J Clin Microbiol. 2011; 49(11): 3983–3985.
  14. Wang M, Ji X, Dou X, et al. Consistency evaluation of Liferiver, Yaneng, Darui, and the Cobas 4800 test for high-risk human papillomavirus screening. J Clin Lab Anal. 2020; 34(12): e23536.
  15. Chigbu CO, Onwudiwe EN, Onyebuchi AK. Thermo-coagulation versus cryotherapy for treatment of cervical precancers: A prospective analytical study in a low-resource African setting. J Obstet Gynaecol Res. 2020; 46(1): 147–152.
  16. Clavel C, Bory JP, Caudroy S, et al. Usefulness of HPV testing in the follow-up of untreated cervical low grade lesions. Histol Histopathol. 2005; 20(4): 1085–1091.
  17. Elfgren K, Jacobs M, Walboomers JMM, et al. Rate of human papillomavirus clearance after treatment of cervical intraepithelial neoplasia. Obstet Gynecol. 2002; 100(5 Pt 1): 965–971.
  18. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee, 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis. 2020; 24(2): 102–131.
  19. Unanyan A, Pivazyan L, Davydova J, et al. Efficacy of photodynamic therapy in women with HSIL, LSIL and early stage squamous cervical cancer: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2021; 36: 102530.
  20. Oga EA, Brown JP, Brown C, et al. Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women. BMC Womens Health. 2016; 16: 25.
  21. Campbell C, Kafwafwa S, Brown H, et al. Use of thermo-coagulation as an alternative treatment modality in a 'screen-and-treat' programme of cervical screening in rural Malawi. Int J Cancer. 2016; 139(4): 908–915.
  22. Dolman L, Sauvaget C, Muwonge R, et al. Meta-analysis of the efficacy of cold coagulation as a treatment method for cervical intraepithelial neoplasia: a systematic review. BJOG. 2014; 121(8): 929–942.
  23. Joshi S, Sankaranarayanan R, Muwonge R, et al. Screening of cervical neoplasia in HIV-infected women in India. AIDS. 2013; 27(4): 607–615.
  24. Katki HA, Gage JC, Schiffman M, et al. Follow-up testing after colposcopy: five-year risk of CIN 2+ after a colposcopic diagnosis of CIN 1 or less. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S69–S77.
  25. Moscicki AB, Shiboski S, Hills NK, et al. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet. 2004; 364(9446): 1678–1683.