Cold Coagulation Versus Cryotherapy for Treatment of Cervical Intraepithelial Neoplasia: Results of a Prospective Randomized Trial

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Abstract
A prospective randomized study is presented of 161 patients with cervical intraepithelial neoplasia (CIN) comparing treatment either by "cold" coagulation or cryotherapy. Following colposcopy with directed biopsy confirmation of CIN, patients were randomized on the basis of their medical record numbers and received outpatient therapy. Seven patients were excluded from analysis of final cure rates. The follow-up period ranged from 3 months to 4 years, with 81% of subjects being followed for longer than 1 year. Of 154 patients assessable for cure following single or repeat treatment using the same modality, 89 had received cold coagulation and 65 cryotherapy. Final cure rates using cold coagulation were for CIN I 95.3%, CIN II 100%, and CIN III 92.6%; the overall cure rate for the three grades combined was 95.5%. In the 65 patients treated with cryotherapy, the final cure rates for CIN I, II, and III were 96.7%, 100%, and 84.2%, respectively, and overall, for the three grades combined, it was 93.8%. There was no statistically significant difference in these cure rates between the two modalities either for each grade of CIN or for all three grades combined. All patients tolerated treatment without discomfort but 2 (1 after each treatment) developed local cervical infection which was cured with outpatient medication. Although both modalities were equally effective, cold coagulation offers several advantages over cryotherapy: easy portability, no gas requirement, it is electrically operated, and it incorporates automatic self-sterilization. Cold coagulation also requires a far shorter treatment time compared to cryotherapy, making it the destructive modality of choice for outpatient CIN therapy.