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The Efficacy of Electrocoagulation Diathermy Performed Under Local Anaesthesia for the Eradication of Precancerous Lesions of the Cervix
Author(s) -
Chanen William
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb01716.x
Subject(s) - medicine , colposcopy , diathermy , cervix , intraepithelial neoplasia , electrocoagulation , cervical intraepithelial neoplasia , cryosurgery , cryotherapy , electrosurgery , papanicolaou stain , genital warts , cidofovir , human papillomavirus , disease , genital tract , hpv infection , gynecology , surgery , cervical cancer , cancer , prostate , virology , physiology , virus
EDITORIAL COMMENT: Elsewhere in this issue Merkur and Baird report the persistence of HPV infection in the majority of patients who originally presented because of an abnormal Papanicolaou smear. It is not easy to compare this with Chanen's paper because the method of treatment was different, and not all patients in Merkur and Baird“s series received treatment. However Chanen's paper reports almost complete eradication of HPV infection as well as associated intraepithelial neoplasia — in his series 62 % of patients (124 of 200) had evidence of HP V infection with or without intraepithelial neoplasia. Is the reader to conclude that electrocoagulation diathermy of the cervix can cure HPV infection, with or without associated intraepithelial neoplasia, in 98% of patients? Chanen's series had cytological and colposcopic follow‐up so one cannot challenge his results — one can only wonder why different centres are reporting such different results in treating what surely must be the same disease. A recent editorial comment in another journal stated ‘There is no satisfactory treatment of papillomavirus infections of the genital tract: Laser, cryosurgery and cautery have each been used, but recurrence rates are high … Problems associated with treatment of sexually transmitted human papillomavirus infections of the female genital tract are the use of surgical methods for treating a medical disease… (Obstet Gynecol Sum 1988; 43:679). The ultimate treatment of human papillomavirus will be to allow it to take its natural course when the patient has no symptoms, and no macroscopic or colposcopic visible lesions, except in those found to have the virus types that are associated with progression to cancer; perhaps a vaccine will ultimately be prepared to protect patients from such infections. In the patient who already has infection with human papillomavirus, treatment should be directed at exclusion of associated intraepithelial neoplasia and the treatment of such lesions. Summary: This study demonstrates the feasibility of performing electrocoagulation diathermy with intracervical infiltration of local anaesthetic for precancerous lesions of the cervix. A technique suitable for office procedure without, need of any supplementary analgesia is described; 200 patients were treated in this fashion with results indicating the ability to obtain high primary cure rates with low morbidity similar to those previously obtained with general anaesthesia.