Is cryotherapy effective in all women with low-grade cervical intraepithelial neoplasia?

Z. Nazari, G. Torabizadeh, A. Khalilian, S. Ghadami, M. Karimi-Zarchi, L. Allahqoli, M. Gharacheh, H. Salehiniya, I. Alkatout

Department of Obstetrics and Gynecology, Mazandaran University of Medical Sciences, Sari, Iran. alesaleh70@yahoo.com

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• Oncology

OBJECTIVE: This study was designed to investigate the incidence the premalignant and malignant cervical lesions at the 12-month follow-up investigation between cryotherapy and non-cryotherapy groups.

PATIENTS AND METHODS: A prospective cohort study was performed in women with CIN 1 and PCB, who were referred to the gynecology clinic at Imam Hospital affiliated to Mazandaran University of Medical Sciences (MAZUMS), Sari, Iran, from February 2015 to November 2019. Of 232 patients, 131 consented to cryotherapy and underwent the treatment, while 101 were unwilling to undergo the treatment. After 12 months, we performed a Pap smear, a colposcopy, and a histopathological investigation of the cervix in both groups. Primary and secondary outcomes were compared between groups. The primary outcome was the comparison of incidence premalignant and malignant cervical lesions in cryotherapy and non-cryotherapy groups. The secondary outcome was a comparison of the accuracy of the Pap smear test versus colposcopy for the detection of premalignant and malignant cervical lesions in women with or without a history of cryotherapy.

PATIENTS: Totally, abnormal cytological, positive colposcopic, and positive histopathological findings were reported in 41.56%, 20.26%, and 13.79 %, respectively. By histology biopsy, premalignant and malignant cervical lesions were reported in 28.24% (37/131) and 36.63% (32/101) of women in the cryotherapy and the non-cryotherapy group, respectively. This statistic did not differ significantly between groups (p = 0.78).

Pap smears were abnormal in 39.7% and 44.5% of women in the cryotherapy and the non-cryotherapy group, respectively. A positive colposcopy was obtained in 27 (20.6%) and 19 (18.8%) women in the cryotherapy and the non-cryotherapy group, respectively. The diagnostic accuracy of the Pap smear test and colposcopy in detecting cervical neoplasia did not differ in women who had undergone cryotherapy and those who had not (p>0.05).

CONCLUSIONS: This prospective study showed that cryotherapy is no appropriate treatment for patients with CIN1 and PCB.

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