Abnormal cervical screening results, such as those from a Pap test, often require further investigation or treatment. Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Conization (CKC) are two common medical procedures used to address these findings. This article clarifies what these procedures involve and the considerations guiding healthcare providers in choosing between them.
Understanding Cervical Dysplasia
Cervical dysplasia refers to abnormal cell changes on the surface of the cervix, the lower part of the uterus that connects to the vagina. These precancerous changes have the potential to develop into cervical cancer if left untreated. The most common cause is infection with certain types of human papillomavirus (HPV).
The severity of cervical dysplasia is graded using Cervical Intraepithelial Neoplasia (CIN), ranging from CIN 1 to CIN 3. CIN 1 represents mild dysplasia, where abnormal cells affect about one-third of the cervical surface thickness. CIN 2 indicates moderate dysplasia, affecting one-third to two-thirds of the thickness, while CIN 3 signifies severe dysplasia or carcinoma in situ, involving more than two-thirds of the cervical epithelium. While CIN 1 often resolves on its own, CIN 2 and CIN 3 usually require treatment to prevent progression to cancer.
LEEP and CKC Explained
LEEP and CKC are excisional procedures that remove a portion of the cervix. Both remove abnormal or precancerous cells, serving diagnostic and therapeutic purposes. The removed tissue is then sent to a laboratory for detailed examination.
LEEP utilizes a thin wire loop heated by an electric current to precisely cut away abnormal tissue. This procedure is often performed in a doctor’s office using local anesthesia. The electrical current also helps to seal blood vessels, minimizing bleeding.
In contrast, CKC removes a cone-shaped piece of cervical tissue using a surgical scalpel or laser. This procedure occurs in an operating room and requires general or regional anesthesia. The larger and deeper sample obtained with CKC can be beneficial for certain cases.
Factors Guiding Procedure Choice
The decision between LEEP and CKC is made by a healthcare provider, considering several factors specific to each patient. The goal is to effectively remove abnormal cells while preserving as much healthy cervical tissue as possible. This personalized approach ensures the most appropriate treatment is chosen.
Severity of Dysplasia
The severity of dysplasia is a primary consideration. Higher grades of dysplasia, such as CIN 3, or cases where the extent of the disease is uncertain, may lead a provider to prefer CKC. This is because CKC typically removes a larger, more comprehensive tissue sample, which can be particularly important for severe changes. For lower grades of dysplasia, LEEP may be a suitable and less invasive option.
Location of Abnormal Cells
The location of the abnormal cells on the cervix also plays a significant role. If the abnormal cells extend high into the endocervical canal (the canal leading into the uterus) or if the entire lesion cannot be fully seen during a colposcopy (a magnified examination of the cervix), CKC might be preferred. CKC allows for a deeper and more complete sample from the endocervical canal.
Diagnostic Test Results
Results from additional diagnostic tests, such as endocervical curettage (ECC), further influence the choice. A positive ECC, which indicates abnormal cells higher within the cervical canal, often points towards the need for a CKC. The pathologist’s review of initial biopsies also guides the decision, recommending the procedure most likely to yield clear margins (edges of the removed tissue free of abnormal cells).
Future Pregnancy Plans
Future pregnancy plans are an important consideration, as both procedures can affect the cervix’s ability to support a pregnancy. CKC, which involves removing a deeper and larger amount of cervical tissue, may carry a slightly higher risk of certain pregnancy complications, such as cervical incompetence (weakening of the cervix) or preterm birth. LEEP is associated with a lower risk of these obstetric complications compared to CKC, making it a preferred choice for individuals who wish to become pregnant in the future, when clinically appropriate.
Preparing for and Recovering from Treatment
Preparation for both LEEP and CKC involves specific instructions. Patients should avoid using tampons, douching, or sexual intercourse for at least 24 hours before the procedure. It is also recommended that the procedure be performed when not on a menstrual period. Patients must inform their healthcare provider about any medications, especially blood thinners, as these may need to be stopped temporarily.
After a LEEP, mild cramping, light bleeding, and a dark or discolored discharge are common. Full recovery for LEEP takes about four to six weeks, during which tampons, douching, and sexual intercourse should be avoided to allow the cervix to heal. Strenuous activities or heavy lifting should also be limited.
Recovery from CKC involves similar symptoms, including cramping and vaginal discharge, but may have a slightly longer initial recovery. Patients undergoing CKC, often under general anesthesia, might experience fatigue for a couple of days. Restrictions on activities such as sexual intercourse, using tampons, and heavy lifting are in place for several weeks, typically four to six weeks, to promote proper healing. Follow-up appointments and continued cervical screenings are important after either procedure to monitor healing and detect any recurrence of abnormal cells.