Excisional biopsy for CIN

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September 2002 · Vol. 14, No. 9

Thanks to technological improvements, LEEP has become the most common excisional technique for squamous dysplasia, although cold-knife conization is preferred when invasive disease is suspected. An expert reviews indications and recommends operative and follow-up strategies.

CHARLES J. DUNTON, MD

Dr. Dunton is director of the division of gynecologic oncology at Albert Einstein Medical Center in Philadelphia.

KEY POINTS

In most cases, loop electrosurgical excision procedure (LEEP) and cold-knife conization (CKC) result in equivalent success rates and margin status.
CKC is preferred in cases of adenocarcinoma in situ or squamous microinvasion.
Conservative follow-up is generally possible in adenocarcinoma in situ and squamous microinvasion when margins are negative.
Colposcopy, endocervical curettage, and biopsies should be part of the follow-up strategy for patients with positive margins.

When cervical intraepithelial neoplasia (CIN) requires treatment, loop electrosurgical excision procedure (LEEP) is the most frequently used modality, although cold-knife conization (CKC) of the cervical transformation zone still is preferred in select cases. Since excisional techniques are used with CKC, margin status is known and clinical decisions may be based on this information.

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