Advantages of radio frequency (RF) cone biopsy compared to large loop excision of the transformation zone (LLETZ) in patients with high-grade squamous intraepithelial lesions: a retrospective study.

OBJECTIVE: The aim of this study was to compare radio wave cone biopsy to the LLETZ method in patients with high-grade squamous intraepithelial lesions. METHOD-RESULTS: This was a retrospective study of 186 patients diagnosed with HGSIL who underwent cone biopsy either with the LLETZ method (82/186) or with the radio wave method (104/186) in the 2nd Obstetrics and Gynecology Department, University of Athens, Aretaieion Hospital, Athens, Greece during the period January 1999 to December 2008. The mean age of the patients was 31 years (range 23 to 53 years). The volume of cone ranged from 1.2 x 2 cm up to 3 x 3.6 cm in both techniques. Histopathological analysis revealed focal or extensive high-grade squamous intraepithelial neoplasia extending into the underlying endocervical glands in 128/186 patients. Concomittent low-grade squamous intraepithelial lesions were observed in 160/186 patients and coilocytic atypia was observed in 172/186 patients. The endocervical margins were free of disease in 172/186 cases. In seven cases the neoplastic lesions were at least 0.1 cm from the margin and in seven cases they extended to the margin. In all cases a degree of tissue coagulative change was observed, but not extensive to the point of obscuring the diagnosis.

CONCLUSION: 4.0 MHz radio wave surgery is an excellent alternative in the treatment of HGSIL. Clear surgical margins due to decreased heat and tissue damage, controlled hemostasis, faster healing, and patient and doctor satisfaction are notable advantages.