Research Article

Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.

BMJ 1990; 300 doi: http://dx.doi.org/10.1136/bmj.300.6741.1690 (Published 30 June 1990) Cite this as: BMJ 1990;300:1690
  1. D M Luesley,
  2. J Cullimore,
  3. C W Redman,
  4. F G Lawton,
  5. J M Emens,
  6. T P Rollason,
  7. D R Williams,
  8. E J Buxton
  1. Department of Obstetrics and Gynaecology, University of Birmingham.

    Abstract

    OBJECTIVE--To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. DESIGN--Prospective programme trial with six month follow up. SETTING--Two hospital based colposcopy clinics. PATIENTS--616 Patients aged 16-60 with abnormal cervical smears. INTERVENTIONS--After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. MAIN OUTCOME MEASURES--Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. RESULTS--Treatment was completed in a mean of 3.47 minutes (SD 1.99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4.4%. CONCLUSION--Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.