Efficacy, Safety, and Acceptability of Thermal Coagulation to Treat Cervical Intraepithelial Neoplasia: Pooled Data From Bangladesh, Brazil and India

Ashrafun Nessa, Paolo Naud, Pulikottil Okkuru Esmy, Smita Joshi, Prabhakaran Rema, Ramani Wesley, Mohammed Kamal, Catherine Sauvaget, Richard Muwonge, Rengaswamy Sankaranarayanan


Background: Treatment of cervical intraepithelial neoplasia (CIN) using thermal coagulation has recently attracted interest among the medical community in view of the easily portable and light equipment, less treatment time, faster patient turnover, less discomfort, use of minimal amounts of electricity as consumable, less vaginal discharge following treatment and a similar efficacy in treatment of ectocervical CIN lesions as compared to cryotherapy. However, literature on its performance is scarce particularly from low- and middle-income settings. Here, we report the effectiveness, safety and acceptability of thermal coagulation in women treated for histologically proven ectocervical CIN.

Methods: We pooled data from five sites in Asia and South America for women treated for CIN with thermal coagulation from March 2010 to October 2015, and followed up within 6 - 12 months after treatment. Estimates of cure, adverse effects, or complications were presented as proportions. Bayesian models were used to assess factors affecting compliance to follow-up and cure rates.

Results: Of the 1,626 women treated for CIN at baseline, 775 (48%) had follow-up evaluation. Attendance for follow-up increased with increasing education and CIN grade, and was less likely to be among those aged >= 40 years. The estimates of the cure after thermal coagulation treatment were 88% (475/543) for CIN 1, 83% (113/137) for CIN 2 and 83% (79/95) for CIN 3 lesions. No serious adverse effects or complications were observed throughout the follow-up period for which hospitalization was required.

Conclusion: Thermal coagulation was effective, safe and accepted in treatment of women diagnosed with CIN. It should be used in the single-visit screen-and-treat approach, see-and-treat approach and in management of ectocervical CIN in cervical cancer control programs.

J Clin Gynecol Obstet. 2017;6(3-4):58-64
doi: https://doi.org/10.14740/jcgo464w



Cervical intraepithelial neoplasia; Thermal coagulation; Efficacy; Acceptability; Pooled data

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