Treatment outcomes for squamous intraepithelial lesions
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Objective: To assess the effectiveness of cone biopsy, cryotherapy, laser ablation and the loop electrosurgical procedure in the treatment of squamous intraepithelial lesions. Method: Systematic review of randomized controlled trials in subjects who underwent treatment of low‐ and high‐grade squamous intraepithelial lesions with these modalities. Main outcome measures included the following: percent resolution and persistence of a lesion and notable complications for each procedure. Result: Pooled rates of resolution for low‐grade, high‐grade, or combined squamous intraepithelial lesions were similar across the different treatment modalities (range 85.2–94.7%), with substantial overlap among the 95% confidence intervals. Significant hemorrhage occurred most frequently in subjects who received cone biopsy (4.6%) (95% CI: 2.15, 6.99), followed by laser ablation (1.75%) (95% CI: 0.70, 2.81), and LEEP (1.35%) (95% CI: 0.24, 2.47). No hemorrhages were reported among subjects who received cryotherapy. Study sample sizes were relatively small. There were no reported cases of progression to invasive cancer, but duration of follow‐up (median follow‐up time for all eligible studies=12 months) was not sufficient to evaluate long‐term outcomes. Conclusions: There were no substantive differences in outcomes regarding persistence and resolution in the treatment of squamous intraepithelial lesions for subjects receiving cone biopsy, cryotherapy, laser ablation, or LEEP.