A 35-year-old woman with CIN 3 is found on colposcopy to have a lesion extending into the endocervical canal that is not fully visualised. Endocervical curettage (ECC) is positive. What is the preferred treatment option?
- A Large loop excision of the transformation zone (LLETZ)
- B Cold knife cone (CKC) biopsy ✓
- C Laser ablation of the transformation zone
- D Radical trachelectomy
Explanation
Cold knife cone biopsy (CKC) is preferred when the squamocolumnar junction is not fully visualised on colposcopy and/or ECC is positive, because adequate sampling of the endocervical canal is necessary to exclude invasive carcinoma and achieve clear margins. LLETZ/LEEP is adequate for Type 1 (fully visible) and many Type 2 (partially endocervical) transformation zones but carries a higher risk of thermal artefact affecting margin assessment and insufficient depth for high-grade endocervical lesions. Laser ablation destroys tissue and does not allow histological assessment. Radical trachelectomy is a fertility-sparing procedure for early invasive cervical carcinoma, not CIN.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.