Destruction of CIN 1 and 2 with the Semm cold coagulator: 13 years' experience with a see-and-treat policy.

OBJECTIVE: To assess the efficacy of the Semm Cold Coagulator (100 degrees C) for CIN 1 and 2 applying a 'see and treat' policy.
DESIGN: Retrospective review of women with CIN 1 and 2 seen and treated at their first visit when specific criteria were satisfied.
SETTING: Colposcopy Clinic, Ninewells Hospital, Dundee.
SUBJECTS: 485 women with CIN 1 and 680 women with CIN 2 confirmed by colposcopically directed biopsy and treated between 1 January, 1978 and 31 December, 1990.
RESULTS: Overall, a 96.7% primary success rate with a single treatment (97.1% for CIN 1, 96.5% for CIN 2) and 99% overall success rate after one or more treatments with the cold coagulator. None of the women developed micro-invasive or invasive cancer and only 1.1% developed CIN 3. In 98.3% treatment was undertaken at their first and only colposcopy clinic attendance. Heavy vaginal bleeding occurred in 1.5% after treatment and 0.6% complained of a heavy vaginal discharge. One woman developed cervical stenosis which required dilatation because of dysmenorrhoea.
CONCLUSION: Cold coagulation at 100 degrees C of CIN 1 and 2 proven by colposcopically directed biopsy using a 'see and treat' policy subject to specific conditions is a safe, cost effective, practical approach. It is more likely to return the cervix to sustained normality than withholding treatment and simply maintaining cytological surveillance, and it should prevent some of the invasive cancers that have been described in reports of management by cytological surveillance.