Specific recommendations and their strength and quality of available evidence

Specific recommendations and their strength and quality of available evidence

Table

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WHO Guidelines: Use of Cryotherapy for Cervical Intraepithelial Neoplasia. Geneva: World Health Organization; 2011. Specific recommendations and their strength and quality of available evidence.

Context	Recommendation		Quality of evidence	Strength
Use of cryotherapy for prevention of CIN	1a	The expert panel recommends cryotherapy over no treatment	⊕○○○	Strong
Use of cryotherapy for prevention of CIN	1b.	In settings where LEEP is available and accessible, the expert panel suggests treatment with LEEP over cryotherapy	⊕⊕○○	Conditional
Lesion size	2.	Among women with CIN lesions covering more than 75% of the ectocervix, or with lesions extending beyond the cryo tip being used, the expert panel suggests performing or referring for excisional therapy	⊕⊕○○	Conditional
Lesions extending into the endocervical canal	3a.	In settings where LEEP is available and accessible, and women present with CIN lesions extending into the cervical canal, the expert panel suggests treatment with LEEP over cryotherapy	⊕⊕○○	Conditional
Lesions extending into the endocervical canal	3b.	In settings where excisional procedures (e.g. LEEP, laser or CKC) or referral to additional treatment are not available, the expert panel suggests that women with lesions extending into the endocervical canal be treated with cryotherapy	⊕○○○	Conditional
Cryotherapy technique and procedure	4.	The expert panel suggests double freeze using a 3 minute freeze, 5 minute thaw, 3 minute freeze cycle over single-freeze cryotherapy	⊕⊕○○	Conditional
	5.	The expert panel recommends cryotherapy using either carbon dioxide (CO₂) or nitrous oxide (N₂O) gas	⊕⊕○○	Strong
	5.	In settings where both gases are available, the expert panel suggests cryotherapy with CO₂ rather than with N₂O	⊕○○○	Conditional
	6.	The expert panel recommends that the “cough technique” should not be used during cryotherapy	⊕○○○	Strong
	7.	The expert panel suggests that prophylactic antibiotics should not be used when providing cryotherapy	⊕○○○	Conditional
Providers	8.	The expert panel recommends that health-care workers (including non-physicians) trained in cryotherapy perform the procedure for women when it is indicated	⊕⊕○○	Strong
Providers	8.	The expert panel also suggests that trained nurses or trained midwives rather than physicians may perform cryotherapy	⊕○○○	Conditional
Use of cryotherapy during pregnancy	9a.	In pregnant women, the expert panel suggests deferring cryotherapy until after pregnancy	⊕○○○	Conditional
Use of cryotherapy during pregnancy	9b.	In women whose pregnancy status is unknown (or there is no clinical evidence of pregnancy), the expert panel suggests using cryotherapy	⊕○○○	Conditional
Retreatment of CIN lesions with cryotherapy	10a.	The expert panel recommends cryotherapy over no treatment for women who screen positive after prior cryotherapy treatment	⊕○○○	Strong
Retreatment of CIN lesions with cryotherapy	10b.	In settings where LEEP is available and accessible, the expert panel suggests treatment with LEEP over cryotherapy for women who screen positive after prior cryotherapy treatment	⊕⊕○○	Conditional

: See full details of recommendations and remarks.