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See and Treat See and Treat 20072007 KRIOTERAPI
Cryotyerapy
Gatot Purwoto, MD
Gyne-OnocologistUniv of Indonesia
JakartaIndonesia
See and Treat See and Treat 20072007 KRIOTERAPI
Cryotherapy
Crisp 1967
Tissue destruction at temperature –20ºC
Freezing Intracelular
Thawing crystalization
CO2 (-600C)
N2O (-900C)
Therapy modality for CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN)
Cellular damage
See and Treat See and Treat 20072007 KRIOTERAPI
Comparable Treatment Modalities for Precancer Lesion (Cervical Intraepithelial Neoplasia)
Procedure Simple Cost Complication Effectifity
Cryotherapy +++ + + 90%
Loop electrosurgical
excision procedure
++ ++ ++ 95%
Laser Ablation ++ +++ ++ 95%
Laser Excision + +++ ++ 95%
Cold-knife Conization ++ +++ ++ 98%
+, Low ++, Middle +++,Good
See and Treat See and Treat 20072007 KRIOTERAPI
cervix
0 0C- 20 0C
2 mm
5 mm
probe
- 85 0C
Recovery zone
Lethal zone
Ice ball freezing 7 mm at < 20ºC - lethal
0 ~ - 20 0C : recovery zone
- 20 ~ - 85 0C : lethal zone
Not effective for tissue depthness
> 5mm
Recovery zone
See and Treat See and Treat 20072007 KRIOTERAPI
Effectivity of Cryotherapy
Temperature of freezing
Duration of freezing
Probe type
Large & grade of the lesion
See and Treat See and Treat 20072007 KRIOTERAPI
Indication
VIA test + Low Grade Lesion (CIN 1 - 2 ) High Grade Lesion (CIN 3 )
Low Grade Lesion : avarage crypt depthness : 1,2 mm
High Grade Lesion : glandular involvement
Cryotherapy only effective for depthness <5 mm
See and Treat See and Treat 20072007 KRIOTERAPI
Preparation
Check cryo-probes, cryo gun, stop watch, speculum, condoms, water soluble jelly.
Cryogun - Gas Tank Connector
Gas pressure (>40kg/cm2)
See and Treat See and Treat 20072007 KRIOTERAPI
Patient Preparation
Counseling: indication, technique, side effects and effectivity
Support not to worry for vaginal discharge (waterish)or slight bleeding/spotting after cryotherapy
Suggest not sexual intercourse for 2-4 weeks after cryoptherapy
See and Treat See and Treat 20072007 KRIOTERAPI
Procedure
Inserting vaginal speculum Clean up surface of the cervix identify aceto-white lesion Applicate water soluble jelly at the tip of cryo-probe Inserting cryo-probe through the speculum into the cervix
Freeze 3 minutes, thaw 3 -5 min, again freeze 3 minutes,
and then defrost formula 3 - 5 - 3 - 5 Take out cryo-probe slowly
See and Treat See and Treat 20072007 KRIOTERAPI
Failure rate of Cryotherapy
One quadrant 6,8%
Two quadrant 14,1%
Hatch (Clin Obstet & Gynecol 1995)
See and Treat See and Treat 20072007 KRIOTERAPI
See and Treat See and Treat 20072007 KRIOTERAPI
Equipment of Cryotherapy
Cryo gun Probes
• liquid gas : CO2 or NO2
• Water suluble jelly• Disinfectant• Speculum • Acetic acid 3 – 5 %
See and Treat See and Treat 20072007 KRIOTERAPI
1. Probe
2. Trigger
3. Handle grip (fiberglass)
4. Yoke
5. Instrument inlet of gas from cylinder
6. Tightening knob
7. Pressure gauge showing cylinder pressure
8. Silencer (outlet)
9. Gas-conveying tube
10. Probe tip
1
7 3
2
6
4
5
8
9
10
See and Treat See and Treat 20072007 KRIOTERAPI
See and Treat See and Treat 20072007 KRIOTERAPI
See and Treat See and Treat 20072007 KRIOTERAPI
See and Treat See and Treat 20072007 KRIOTERAPI
Advantage & disadvantage of Cryotherapy
Advantage Disadvantage
Effective for CIN 1-3
Simple procedure No specimen for pathology
No need electicity Watery discharge
No need anesthesia
See and Treat See and Treat 20072007 KRIOTERAPI
Side Effect
Pelvic cramp (like menstruation)
Watery discharge 2-4 weeks
Spotting
Sometime Pelvic Inflamatory Disease (< 1%)
See and Treat See and Treat 20072007 KRIOTERAPI
Efectivity
CIN 1 CIN 2 CIN 3
Berget, ‘91 90.9 90.9 86.4
Olatunbosun, ’92 83.3 96.9 80.8
Tangtrakul, ‘83 88.9 85.7 78.5
Double FreezeDouble Freeze cytology + histologic + colposcopy confirmation @ 1 year
See and Treat See and Treat 20072007 KRIOTERAPI
TAKE HOME MESSAGES
Effective in precancer lesion
Cheap (Affordable)
Acceptable
Safe
