{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T07:14:03Z","timestamp":1787987643963,"version":"build-2784847793"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Among the treatment modalities for high-grade cervical intraepithelial neoplasia (CIN), large-loop excision of the transformation zone (LLETZ) is the commonest offered in the UK, whereas thermal ablation (TA) has not been common in several decades, despite several notable advantages. TA and LLETZ are both routinely undertaken in our colposcopy unit, and extensive follow-up data have been used to interrogate outcomes between the two modalities and determine whether one modality may be preferred over the other.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Up to 8 years of follow-up data (cytology and histology) were collected for patients who have undergone LLETZ or TA and failed post-treatment test of cure (ToC). These data were analysed and used to plot Kaplan\u2013Meier survival curves, in order to compare outcomes: negative cytology, dyskaryosis, low- and high-grade CIN and invasive squamous cell carcinoma.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>i) Very few women treated with TA developed recurrent high-grade CIN in the follow-up period; (ii) LLETZ-treated women had a significantly higher rate of recurrence than those treated by TA; (iii) women who failed both virology and cytology components of post-treatment ToC had higher recurrence than those who failed only one, and the rate of recurrence was highest in those treated by LLETZ (&gt; 65%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>TA is an effective treatment of high-grade CIN, with a high chance of achieving double-negative ToC and low recurrence relative to LLETZ. We recommend the wider adoption of TA, so that young women of reproductive age have a choice of treatment with no reported adverse effects on pregnancy outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00404-022-06409-3","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T11:05:51Z","timestamp":1643799951000},"page":"1815-1820","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Test of cure and beyond: superiority of thermal ablation over LLETZ in the treatment of high-grade CIN"],"prefix":"10.1007","volume":"306","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3052-6292","authenticated-orcid":false,"given":"G. M.","family":"Armstrong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Ragupathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,2]]},"reference":[{"key":"6409_CR1","unstructured":"Cancer Research UK, https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/cervical-cancer. Accessed Jun 2021."},{"issue":"5","key":"6409_CR2","doi-asserted-by":"publisher","first-page":"E359","DOI":"10.1002\/ijc.29210","volume":"136","author":"J Ferlay","year":"2015","unstructured":"Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359-386","journal-title":"Int J Cancer"},{"key":"6409_CR3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.semcancer.2013.11.002","volume":"26","author":"M Tommasino","year":"2014","unstructured":"Tommasino M (2014) The human papillomavirus family and its role in carcinogenesis. Semin Cancer Biol 26:13\u201321","journal-title":"Semin Cancer Biol"},{"issue":"12","key":"6409_CR4","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1002\/cncr.30588","volume":"123","author":"TA Berman","year":"2017","unstructured":"Berman TA, Schiller JT (2017) Human papillomavirus in cervical cancer and oropharyngeal cancer: one cause, two diseases. Cancer 123(12):2219\u20132229","journal-title":"Cancer"},{"issue":"Suppl 5","key":"6409_CR5","doi-asserted-by":"publisher","first-page":"F88","DOI":"10.1016\/j.vaccine.2012.06.095","volume":"30","author":"M Arbyn","year":"2012","unstructured":"Arbyn M, Ronco G, Anttila A, Meijer CJLM, Poljak M, Ogilvie G et al (2012) Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 30(Suppl 5):F88-99","journal-title":"Vaccine"},{"issue":"4","key":"6409_CR6","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1097\/00003081-198312000-00022","volume":"26","author":"ID Duncan","year":"1983","unstructured":"Duncan ID (1983) The Semm cold coagulator in the management of cervical intraepithelial neoplasia. Clin Obstet Gynecol 26(4):996\u20131006","journal-title":"Clin Obstet Gynecol"},{"issue":"1","key":"6409_CR7","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/S0950-3552(05)80363-3","volume":"9","author":"ID Duncan","year":"1995","unstructured":"Duncan ID (1995) Cold coagulation. Baillieres Clin Obstet Gynaecol 9(1):145\u2013155","journal-title":"Baillieres Clin Obstet Gynaecol"},{"issue":"1","key":"6409_CR8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1111\/j.1471-0528.1991.tb10304.x","volume":"98","author":"HK Gordon","year":"1991","unstructured":"Gordon HK, Duncan ID (1991) Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience. Br J Obstet Gynaecol 98(1):14\u201320","journal-title":"Br J Obstet Gynaecol"},{"issue":"5","key":"6409_CR9","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1111\/j.1471-0528.1993.tb15273.x","volume":"100","author":"HA Loobuyck","year":"1993","unstructured":"Loobuyck HA, Duncan ID (1993) Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years\u2019 experience with a see-and-treat policy. Br J Obstet Gynaecol 100(5):465\u2013468","journal-title":"Br J Obstet Gynaecol"},{"issue":"1","key":"6409_CR10","first-page":"63","volume":"69","author":"OE Williams","year":"1993","unstructured":"Williams OE, Bodha M, Alawattegama AB (1993) Outcome of cold coagulation for the treatment of cervical intraepithelial neoplasia in a department of genitourinary medicine. Genitourin Med 69(1):63\u201365","journal-title":"Genitourin Med"},{"issue":"7","key":"6409_CR11","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1016\/0002-9378(66)90546-1","volume":"95","author":"K Semm","year":"1966","unstructured":"Semm K (1966) New apparatus for the \u2018cold-coagulation\u2019 of benign cervical lesions. Am J Obstet Gynecol 95(7):963\u2013966","journal-title":"Am J Obstet Gynecol"},{"key":"6409_CR12","doi-asserted-by":"crossref","unstructured":"Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL (2010) Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev (6):CD001318.","DOI":"10.1002\/14651858.CD001318.pub2"},{"issue":"4","key":"6409_CR13","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1111\/1471-0528.2012.03505.x","volume":"120","author":"V O\u2019Dwyer","year":"2013","unstructured":"O\u2019Dwyer V, Madden M, Hickey K (2013) Cold coagulation to treat cervical intraepithelial neoplasia. BJOG Int J Obstet Gynaecol 120(4):510\u2013510","journal-title":"BJOG Int J Obstet Gynaecol"},{"issue":"9","key":"6409_CR14","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1136\/jcp.47.9.799","volume":"47","author":"AI Al-Nafussi","year":"1994","unstructured":"Al-Nafussi AI, Hughes DE (1994) Histological features of CIN3 and their value in predicting invasive microinvasive squamous carcinoma. J Clin Path 47(9):799\u2013804","journal-title":"J Clin Path"},{"issue":"1","key":"6409_CR15","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/LGT.0000000000000031","volume":"19","author":"W Parry-Smith","year":"2015","unstructured":"Parry-Smith W, Underwood M, De Bellis-Ayres S, Bangs L, Redman CW, Panikkar J (2015) Success rate of cold coagulation for the treatment of cervical intraepithelial neoplasia: a retrospective analysis of a series of cases. J Low Genit Tract Dis 19(1):17\u201321","journal-title":"J Low Genit Tract Dis"},{"issue":"8","key":"6409_CR16","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1111\/1471-0528.12655","volume":"121","author":"L Dolman","year":"2014","unstructured":"Dolman L, Sauvaget C, Muwonge R, Sankaranarayanan R (2014) Meta-analysis of the efficacy of cold coagulation as a treatment method for cervical intraepithelial neoplasia: a systematic review. BJOG 121(8):929\u2013942","journal-title":"BJOG"},{"issue":"4","key":"6409_CR17","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1007\/s00404-017-4306-z","volume":"295","author":"D Papoutsis","year":"2017","unstructured":"Papoutsis D, Underwood M, Parry-Smith W, Panikkar (2017) Comparison of cure rates in women treated with cold-coagulation versus LLETZ cervical treatment for CIN2-3 on pretreatment cervical punch biopsies: a retrospective cohort study. Arch Gynecol Obstet 295(4):979\u2013986","journal-title":"Arch Gynecol Obstet"},{"issue":"6","key":"6409_CR18","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1002\/ijc.33290","volume":"148","author":"X-L Zhao","year":"2021","unstructured":"Zhao X-L, Liu Z-H, Zhao S, Hu S-Y, Muwonge R, Duan X-Z, Du L-J, Su C-F, Xiang X-E, Zhang X, Pan Q-J, Qiao Y-L, Sankaranarayanan R, Zhao F-H, Basu P (2021) Efficacy of point-of-care thermal ablation among high-risk human papillomavirus positive women in China. Int J Cancer 148(6):1419\u20131427","journal-title":"Int J Cancer"},{"issue":"9","key":"6409_CR19","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1111\/j.1471-0528.2011.02944.x","volume":"118","author":"F Bruinisma","year":"2011","unstructured":"Bruinisma F, Quinn M (2011) The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis. BJOG 118(9):1031\u20131041","journal-title":"BJOG"},{"key":"6409_CR20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3633","volume":"354","author":"M Kyrgiou","year":"2016","unstructured":"Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hisch P et al (2016) Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: a systematic review and meta-analysis. BMJ 354:i3633","journal-title":"BMJ"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-022-06409-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-022-06409-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-022-06409-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T04:05:34Z","timestamp":1664337934000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-022-06409-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,2]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["6409"],"URL":"https:\/\/doi.org\/10.1007\/s00404-022-06409-3","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,2]]},"assertion":[{"value":"13 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}