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| ==Treatment== | | ==Treatment== |
| Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include: | | Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include: |
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| *[[Cryosurgery]] to freeze abnormal cells | | *[[Cryosurgery]] to freeze abnormal cells |
| *Laser therapy, which uses light to burn away abnormal tissue | | *Laser therapy, which uses light to burn away abnormal tissue |
| ==LEEP (loop electrosurgical excision procedure)==
| | *LEEP (loop electrosurgical excision procedure) |
| The '''loop electrosurgical excision procedure''' ('''LEEP''') is one of the most commonly used approaches to treat high grade [[cervical dysplasia]] (CIN II/III, HGSIL) discovered on [[colposcopy|colposcopic]] examination. In the UK it is known as '''large loop excision of the transformation zone''' ('''LLETZ''').<ref>{{cite web |url=http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes |title=Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes |accessdate=2007-12-28}}</ref> The procedure has many advantages including low cost, high success rate, and ease of use. The procedure can be done in an office setting and usually only requires a local [[anesthesia|anesthetic]], though sometimes IV sedation or a general [[anesthesia|anesthetic]] is used.<ref>{{cite web |url=http://lib-sh.lsuhsc.edu/fammed/atlases/leep/leepadv.html |title= Advantages of LEEP|accessdate=2007-12-28 |last=Mayeaux, Jr. |first= E.J. }}</ref>
| | **Surgery to remove the abnormal tissue (cone biopsy) |
| ===Process===
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| When performing a LEEP, the [[physician]] uses a wire loop through which an electric current is passed at variable power settings. Various shapes and sizes of loop can be used depending on the size and orientation of the lesion. The [[cervix|cervical]] transformation zone and [[lesion]] are excised to an adequate depth, which in most cases is at least 8 mm, and extending 4 to 5 mm beyond the lesion. A second pass with a more narrow loop can also be done to obtain an endocervical specimen for further [[histology|histologic]] evaluation.<ref>{{cite web |url=http://womenshealth.about.com/cs/surgery/a/leepprocedure.htm|title= LEEP Procedure — What is LEEP? — Loop Electrosurgical Excision Procedure|accessdate=2007-12-28 |date=Tracee |work= Cornforth|publisher=About.com}}</ref>
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| The LEEP technique results in some thermal artifact in all specimens obtained due to the use of electricity which simultaneously cuts and cauterizes the lesion, but this does not generally interfere with [[pathology|pathological]] interpretation.
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| ===Complications===
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| Complications are less frequent in comparison to a [[cervical conization|cold knife conization]], but can include [[infection]] and [[hemorrhage]].
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| A survey study has indicated that the LEEP procedure does not appear to affect [[fertility]].<ref>{{cite journal |author=Turlington WT, Wright BD, Powell JL |title=Impact of the loop electrosurgical excision procedure on future fertility |journal=J Reprod Med |volume=41 |issue=11 |pages=815–8 |date=November 1996 |pmid=8951130 }}</ref> On the other hand, a [[case-control study]] has found an association between surgical treatment of CIN lesions and risk of [[female infertility|infertility]] or subfertility, with an odds ratio of approximately 2.<ref>{{Cite journal | last1 = Spracklen | first1 = C. N. | last2 = Harland | first2 = K. K. | last3 = Stegmann | first3 = B. J. | last4 = Saftlas | first4 = A. F. | title = Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: A case-control study | doi = 10.1111/1471-0528.12209 | journal = BJOG: an International Journal of Obstetrics & Gynaecology | volume = 120 | issue = 8 | pages = 960–965 | year = 2013 | pmid = 23489374 | pmc =3691952 }}</ref> Scarring of the cervix is a theoretical mechanism of causing trouble conceiving. This scar tissue can be massaged or broken up in a number of ways, thus allowing the cervical opening to dilate back to normal size.
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| A cohort study came to the result that women with a time interval from LEEP to pregnancy of less than 12 months compared with 12 months or more were at significantly increased risk for [[spontaneous abortion]], with risk of miscarriage of 18% compared with 4.6%, respectively.<ref name="pmid24201682">{{cite journal| author=Conner SN, Cahill AG, Tuuli MG, Stamilio DM, Odibo AO, Roehl KA et al.| title=Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes. | journal=Obstet Gynecol | year= 2013 | volume= 122 | issue= 6 | pages= 1154-9 | pmid=24201682 | doi=10.1097/01.AOG.0000435454.31850.79 | pmc=PMC3908542 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24201682 }} </ref> On the other hand, no increased risk was identified for [[preterm birth]] after LEEP.
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| *Surgery to remove the abnormal tissue (cone biopsy) | |
| Rarely, a [[hysterectomy]] may be needed. Women treated for dysplasia need close follow-up, usually every 3 to 6 months or as recommended by their provider. | | Rarely, a [[hysterectomy]] may be needed. Women treated for dysplasia need close follow-up, usually every 3 to 6 months or as recommended by their provider. |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Cervical dysplasia is curable although the lifetime recurrence rate is 20%. Methods used to cure cervical dysplasia require destruction of the surface cells of the cervix. These methods include cryocautery, electrocautery, laser cautery, LEEP, and cervical conization.
Treatment
Treatment for moderate-to-severe dysplasia or mild dysplasia that does not go away may include:
- Cryosurgery to freeze abnormal cells
- Laser therapy, which uses light to burn away abnormal tissue
- LEEP (loop electrosurgical excision procedure)
- Surgery to remove the abnormal tissue (cone biopsy)
Rarely, a hysterectomy may be needed. Women treated for dysplasia need close follow-up, usually every 3 to 6 months or as recommended by their provider.
References
Template:WikiDoc Sources