Efficacy, acceptability and safety of ablative versus excisional procedure in the treatment of histologically confirmed CIN2/3: A systematic review.

Background: Outcomes of earlier systematic reviews of the efficacy of ablative and excisional techniques to treat cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) were biased, as most of the included studies did not compare the techniques head‐to‐head. Objective: To systematically review the outcomes of studies comparing ablative and excisional techniques to treat CIN2/3 head‐to‐head. Search strategy: Medline, Embase and Global Index Medicus were searched from inception until May 2021. Selection criteria: Studies directly comparing the efficacy and safety of excisional and ablative treatments on histologically confirmed CIN2/3. Eligibility criteria for the women treated with ablation had to be same as those treated with excision. Data collection and analysis: A total of 323 articles were archived. Data on the risk of persistence/recurrence and safety were extracted from the original trials. Comparison between the two procedures was reported by forest plots, stratified by follow‐up intervals and by HIV status. Main results: Six publications were included. The risk of persistence/recurrence following ablation was significantly higher than that following excision (overall, RR 1.65, 95% CI 1.25–2.19; at 6‐month follow‐up, RR 1.94, 95% CI 1.29–2.91; at 12‐month follow‐up, RR 1.78, 95% CI 1.27–2.51; at 24‐month follow‐up, RR 1.57, 95% CI 1.11–2.23). The findings remained similar among women living with HIV (WLHIV). Both procedures were equally safe. Conclusions: Excisional treatment was more effective than ablative treatment, with both procedures having similar safety profiles. Other programmatic considerations will guide the selection of technique, especially in resource‐limited settings. Excisional treatment is more effective than ablative treatment for histology‐confirmed CIN2/3. Linked article: This article is commented on by Dimitrios Papoutsis, pp. 162 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17254. [ABSTRACT FROM AUTHOR]