Managing cervical dysplasia requires selecting optimal high-grade CIN procedures to prevent recurrence and progression. Specifically, clinicians frequently choose between cold knife conization (CKC) and loop electrosurgical excision procedure (LEEP). However, data comparing long-term repeat procedure rates after these two excisional modalities remain limited. Therefore, researchers evaluated long-term diagnostic and therapeutic intervention rates in a massive cohort of over 117,000 patients.
Comparing Outcomes of High-Grade CIN Procedures
The study analyzed commercial database records from 2008 to 2021. Specifically, the cohort included 13,147 patients who underwent CKC and 104,088 patients who had LEEP. Furthermore, investigators applied propensity score matching to balance baseline patient characteristics. After matching, researchers monitored patients for up to 36 months to evaluate outcomes.
Key Diagnostic and Therapeutic Findings
The results revealed distinct post-procedure clinical trajectories. Notably, patients undergoing LEEP experienced higher rates of repeat diagnostic evaluation than those receiving CKC (21.2% vs 19.7%). Similarly, repeat excisional procedures occurred more frequently after LEEP compared to CKC (4.3% vs 2.8%). Conversely, patients treated with CKC demonstrated higher subsequent rates of hysterectomy for dysplasia (4.9% vs 4.1%). Additionally, CKC recipients showed higher rates of cervical cancer diagnosis (1.2% vs 0.7%).
Clinical Implications for Gynecologic Practice
These findings highlight important nuances for surgical decision-making. Consequently, LEEP leads to a higher likelihood of manageable residual disease or local recurrence. In contrast, higher hysterectomy and cancer rates after CKC likely reflect initial baseline lesion severity rather than treatment failure. Overall, clinicians must counsel patients about specific post-procedure monitoring requirements. Furthermore, rigorous post-excision follow-up remains mandatory regardless of the initial treatment modality.
Frequently Asked Questions
Q1: Why does LEEP show higher repeat excisional rates compared to CKC?
LEEP typically yields shallower tissue specimens than CKC, which may leave residual dysplasia in deeper or endocervical margins, requiring repeat excision.
Q2: Why was CKC associated with higher rates of hysterectomy and cervical cancer?
Clinicians often reserve CKC for patients presenting with more severe, extensive, or glandular lesions, which inherently carry a higher risk of persistent or progressive malignancy.
Q3: Is post-procedure colposcopic follow-up required after both procedures?
Yes, both procedures carry a substantial risk of repeat diagnostic evaluation near 20%, making close colposcopic surveillance essential for all patients.
References
- Onyirimba B et al. Repeat Diagnostic and Therapeutic Procedures After Excisional Procedures for High-Grade Cervical Intraepithelial Neoplasia. Obstet Gynecol. 2026 Jul 24. doi: 10.1097/AOG.0000000000006387. PMID: 42492079.
- Yi X et al. Long-Term Outcomes After Cervical Cold Knife Conization or Loop Electrosurgical Excision Procedure. JAMA Surg. 2026. doi: 10.1001/jamasurg.2026.0123.