Loop Electrosurgical Excision Procedure vs. Cold Knife Cone in Treatment of Cervical Intraepithelial Neoplasia: Review of 447 Cases

Loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC) are often used for the treatment of high-grade cervical intraepithelial lesions. LEEP is an in-office procedure with less discomfort and fewer complications than CKC. However, concerns related to LEEP include the interpretability of the resection margins, positive margins, and the tissue fragmentation. Negative for dysplasia in LEEP or CKC specimens are not uncommon, which may be associated with lesion regression or interpretation errors. 447 cases with 259 LEEP and 188 CKC were included in this study. Patients with CKC were significantly older than patients with LEEP (38 vs. 31, p=0.0001). LEEP was associated with more tissue fragmentation (45.2% vs. 8.5%, p=0.0001) and un-interpretable surgical margins than CKC (10.4% vs. 2.7%, p=0.001). LEEP and CKC had similar positive surgical margin rate. 380 cases had both in-house biopsy and LEEP/CKC (219 LEEP and 161 CKC) specimens. Twenty four cases were negative for dysplasia on the LEEP/CKC (6.3%, 24/380), and the negative rates were similar between LEEP and CKC groups (6.8% vs. 5.6%, p=0.67). Reviewing the previous biopsy or cytology of the 24 negative cases confirmed high-grade squamous intraepithelial lesion (HSIL/CIN2+) in 22 cases, and the remaining 2 cases were misinterpretations of low-grade squamous intraepithelial lesion (LSIL/CIN1) in the biopsy or cytology. The negative rate was higher in cervical cytology only group comparing to cervical biopsy confirmed CIN2+ group (10.8% vs. 5.4%), but it was not statistically significant (p=0.15). The residual/recurrent rate for cervical dysplasia was only 2.9% (11/373).