Have we dismissed ablative treatment too soon in colposcopy practice?

摘要

The large retrospective linkage cohort study by Bminsma et al. (p. 70) in this issue supports the findings of a meta-analysis by Kyrgiou et al. recently published in the Lancet, confirming that excisional treatments for cervical intraepithe-lial neoplasia (CIN)-such as large loop excision of the transformation zone (LLETZ), cold knife and laser cone-adversely affect future pregnancy outcomes. Such treatments increase the likelihood of preterm delivery, and as a consequence, there is a trend of higher perinatal mortality. Laser ablation does not appear to produce such adverse outcomes. Although there are currently no data on other destructive methods such as cryotherapy and cold coagulation, it is likely that they are more similar to laser ablation than to LLETZ. This recent evidence on adverse pregnancy outcomes following excisional treatment, together with our knowledge that only a small proportion of low-grade disease progresses and subsequent invasion rates are extremely low, should result in an alteration in current practice to avoid excisional treatment in young, nulliparous women.