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PubMed2000

[LEEP versus cold knife conization for treatment of cervical intraepithelial neoplasias].

OBJECTIVE: This study was performed to evaluate the effectiveness and side effects of loop electrosurgical excision procedure (LEEP) in comparison to cold knife conization for the treatment of cervical intraepithelial neoplasia (CIN). MATERIAL AND METHODS: Between January 1996 and July 1998, 177 patients underwent conization. In a matched-pair setting, 50 cases with LEEP were compared with 100 classical conization cases. LEEP was performed with ectocervical and endocervical excision. RESULTS: Perioperative complications were less in the LEEP group (6% vs. 11%). The mean volume of LEEP specimens (1.6 cm3) was significantly smaller than the volume of cone specimens (2.6 cm3). Thermal artifacts were negligible. There were no significant differences in the proportion of margin involvement (20% vs. 19%) and residual/recurrent CIN. The endocervical excision contained dysplastic tissue in 38% of the cases; more important, a positive endocervical excision was found in 14/21 CIN 3 cases (67%). The success rate, was similar in both groups (96% vs. 97%). Hospitalization time was less for the LEEP group. CONCLUSIONS: LEEP conization is a safe and cost effective procedure with a lower complication rate providing a significantly smaller specimen compared to cold knife conization. Therefore, LEEP conization may substitute cold knife conization. However, we do recommend to perform LEEP conization with an endocervical excision to reduce residual CIN.

Adult↗

PubMed2000

Margin clearance and HPV infection do not influence the cure rates of early neoplasia of the uterine cervix by laser conization.

A lesion existing in the endocervical and/or ectocervical conized margin and HPV-DNA existing in a conized specimen are reported to be at risk of persistence or recurrence of early neoplasia of the cervix when treated by conization. The aim of this study was to investigate whether margin clearance and HPV infection influenced the outcome in our series of laser conization. Excisional conization with the KTP/YAG Surgical Laser System or Nd-YAG laser was performed in this study. Eighty patients with cervical neoplasias were included: 47 with dysplasia, 25 with carcinoma in situ (CIS) and eight with microinvasive carcinoma. The endocervical and ectocervical conized margins were examined microscopically. HPV-DNA was analyzed with the primer for types 16, 18, 31, 33, 35, 52b and 58 amplified by the PCR method. The margins of the conized specimens were confirmed histopathologically to be clear in 58 cases (73%), whereas in 22 cases (27%) they were involved by neoplasia. HPV-DNA was positive in 38% of dysplasias, 40% of CISs and 50% of microinvasive carcinomas. The overall rate of the initial cure at 10 weeks after treatment appeared to be 100% in all 80 cases. Primary cure rates were 100% for 47 cases with dysplasia, 96% for 24 cases with CIS and 100% for four cases with microinvasive carcinoma regardless of margin positivity and HPV-DNA status. Involved margins and HPV infection did not influence the cure of early neoplasia of the uterine cervix achieved by our laser conization procedure. The favorable results may be due to the procedure of vaporizing the cut surface forming a dome-shaped tissue defect.

Conization↗

PubMed2002

[Complications, sequellae and outcome of cervical conizations: evaluation of three surgical technics].

OBJECTIVES: To assess complications and after-effects of conizations and follow-up of patients treated with 3 conization methods. Materials and methods. Two hundred and forty-one conizations were performed for cervical dysplasia using cold knife (100 cases), electric knife (39 cases) or loop electrosurgical excision (102 cases). Residual disease, post-operative bleeding, cervical stenosis and recurrences were assessed. RESULTS: The height of the cone biopsy specimen was higher after cold knife conization (18.3 4.7 mm) and electric knife conization (18.4 0.7 mm) than after loop electrosurgical excision (12.8 3.5 mm) (P<0.001). However, the rate of positive margins for dysplasia was not significantly different: 7%, 8% and 14%, respectively. The rate of post-operative bleeding was 8%, 5% and 2%, respectively. The rate of cervical stenosis was 8%, 27% and 3%, respectively (P<0.001). The rate of recurrences was not significantly different: 8%, 15% and 11%, respectively. CONCLUSION: Taking into account the current trend not to repeat surgery systematically after positive margin conizations, the risk of bleeding after cold knife conization, the risk of stenosis after electric knife conization and excessive depth of cone excision, the loop electrosurgical procedure may be recommended as a first option to treat cervical dysplasia.

Adolescent↗

PubMed2003

[Diagnostic conization of the uterine cervix and its effect on survival of patients after Wertheim-Meigs hysterectomy].

The aim of this retrospective work was to evaluate the diagnostic conization and its influence on morbidity and survival of patients with cervical cancer IB and IIA stage after radical hysterectomy a modo Wertheim-Meigs. The impact and influence of the irradical conization on the lymph node metastases and prognosis was analyzed. 535 patients in stage IB and IIA were examined for the period of 1990 and 2002. All of them were radically operated by Wertheim-Meigs method. There were 35 patients mainly from the countryside, who were treated by conization priory to radical hysterectomy. The time interval between the conization and the radical hysterectomies was between 5 and 8 weeks. The surgical morbidity and death incidence for patients with prior conization was not significantly different from other patients with directly radical hysterectomies. The survival was not significantly different between the two groups (84% vs 81%, p = 0.21). The Multivariate analysis which we used showed us that the irradical conization is not connected with higher risk of metastases or poor prognosis. We think that in early cervical cancer, the diagnostic conization has no adverse negative effect on the following radical hysterectomy a modo Werheim-Meigs. The irradical conization has no influence on prognosis.

Cervix Uteri↗

PubMed2004

Outcome after treatment of high-grade squamous intraepithelial lesions: relation between colposcopically directed biopsy, conization and cervical loop excision.

PURPOSE OF INVESTIGATION: The hypothesis that cold-knife conization performed in women with high-grade squamous intraepithelial lesions (HSIL) and unsatisfactory colposcopy is a better procedure than the loop electrosurgical procedure (LEEP) is tested. METHODS: A retrospective study was conducted in conization specimens of women submitted to LEEP (n = 102) or conization (n = 245) due to HSIL. Age, biopsy, compromised surgical margins in conization, and recurrence were analysed. RESULTS: The frequency of invasion, non-compromised margins, and recurrence in conization and LEEP were, respectively, 7.7% versus 2.9%, 64.1% versus 48% (p = 0.008), and 33.8% versus 24.1%. Eight (42.1%) and five (26.3%) of 19 women submitted to conization where invasion was found in surgical specimens were, respectively, menopausal or had unsatisfactory colposcopy. Twenty-five (96.2%) of 26 and 23 (95.8%) of 24, respectively, undergoing conization and LEEP had recurrence in the first five years. CONCLUSION: We recommend the use of cold-knife conization in cases where the lesion is located deep in the cervical canal.

Adult↗

PubMed1992

Cervical conization: cold knife and laser excision in residency training.

During a 2-year period, 293 consecutive conizations performed by residents in obstetrics and gynecology were reviewed. One hundred sixty-one patients underwent laser excision and 132 women were treated by cold knife conization. Average operating times for laser excision and knife conization were 31 and 33 minutes, respectively. Combined minor and major complication rates for laser and knife cones were 19 and 30%, respectively. Major complications including cervical stenosis and heavy bleeding were seen in 20% of knife conizations and 6% of laser excisions. Average blood loss for knife conization was 65 mL, and average blood loss for laser conization was 34 mL. Among those examined in follow-up with cervical cytology and colposcopy, no patient in the laser excision group showed evidence of persistent dysplasia, compared with one patient (3%) in the knife conization group. The reported data suggest no difference in operating time, length of anesthesia, or success of treatment between laser excision and knife conization performed by residents in training. Fewer complications were seen in the laser excision group.

Anesthesia, Obstetrical↗

PubMed1992

Laser vaporization conization.

Laser vaporization conization is a modified technique for the diagnosis and treatment of cervical intraepithelial neoplasia. Two circles are marked on the cervix with the laser; the inner circle outlines the circumference of the conization specimen, while the outer one outlines an area 3 mm peripheral to all colposcopically abnormal tissue. The area between the circles is vaporized to 7 mm. This initial vaporization allows easier manipulation of the conization specimen. Laser conization is then performed. This technique is significantly easier to perform than laser excisional conization or combination excisional-vaporization conization and thus is ideal for teaching residents laser conization. Besides ease of performance, laser vaporization conization retains the advantages of laser vaporization and provides a specimen for pathologic review. In this study the median laser time was 14 minutes. There was minimal operative hemorrhaging, and only one patient (2%) developed a secondary cervical hemorrhage. A significant laser artifact was present in one case (2%). One case of invasive squamous cell cancer was diagnosed.

Adult↗

PubMed1986

[Determination of residual lesion in remaining uterus after conization].

For the purpose of predicting the residual lesion in the remaining uterus after conization, the relationship between the residual lesion in the extirpated uterus and the foci in conization specimens was examined. Seventy-seven cases with severe dysplasia, carcinoma in situ and early invasive carcinoma of the uterine cervix diagnosed by punch biopsy were reviewed. The histopathologic diagnosis, the distance from the conization stump to the focus, the length of the focus along the cervical canal, the size of the conization specimens, the number of blocks containing a focus and so on were investigated. It is concluded that there is no residual lesion in the remaining uterus after conization when the following criteria are satisfied. The histopathologic diagnosis is Ia or less. The conization stump is not involved. The distance from the conization stump to the focus is more than 3.1mm and the length of the lesion along the cervical canal is less than 8.5mm. The distance from the conization stump to the focus is no more than 3.1mm, gland involvement is not recognized in this area and the length of the lesion along the cervical canal is less than 8.5mm.

Adult↗

PubMed1976

[Results of the conservative management of carcinoma in situ of the uterine cervix by conization (author's transl)].

From 1958 to 1969 conizations for carcinoma in situ of the uterine cervix were carried out in 683 women. In 523 cases no further therapy was instituted immediately. Step serial sections of the conization specimens showed that carcinoma in situ was completely removed in 346 (66.2%) of the cases. In 177 (33.8%) of the cases, the excision of the atypical epithelium was incomplete or not with certainty complete, by the conization. Of these patients 43 women were older than 45 years. Follow-up examinations after conization with complete removal of all atypical epithelium showed that only one case showed again a pathological epithelium. In this case, hysterectomy for an adnexal tumor four years after conization showed a mild dysplasia of the endocervix. Follow-up examination of the cases with incomplete or possibly incomplete conization showed no further pathological finding in 90% of the cases. In 19 (10.7%) of the women, atypical epithelium reappeared after varying lengths of follow-up. In 4 women, invasive carcinoma had developed and in 2 women, microinvasive carcinoma had developed. Following operative treatment, further follow-up examinations in these patients were negative. Conization of the uterine cervix with complete removal of all atypical epithelium is shown to be adequate treatment for carcinoma in situ. In cases with incomplete or not with certainty complete removal of atypical tissue by conization, individual follow-up is necessary. If further pregnancies are desired the small risk of observation is justifiable. Diagnosed persistence of atypical epithelium is an indication for a hysterectomy. Hysterectomies are also necessary if the patient does not comply adequately with the follow-up protocol.

Adult↗

PubMed2004

Laser CO(2) conization: a safe mode of treating conservatively microinvasive carcinoma of the uterine cervix.

OBJECTIVE: To evaluate the outcome of conservative treatment by laser CO(2) conization, for the management of microinvasive carcinoma of the uterine cervix (MIC). STUDY DESIGN: From 1990 to 1999, 90 women with the diagnosis of MIC were treated in the Gynecological Oncology Unit of "Alexandra" Hospital. Final diagnosis of MIC was based on cervical conization as well as simple and radical hysterectomy specimens. The cytological and colposcopical diagnoses prior to conization were reviewed. The cone specimen parameters examined by the pathologists were depth and width of invasion, lymph-vascular space invasion (LVSI) and surgical margins status. The modality used for all conizations, either primary or secondary, was the laser CO(2) under local anaesthesia. RESULTS: Diagnosis of MIC was made on cone biopsy in 73 women (81%), in simple hysterectomy in 10 (11%) and in radical hysterectomy specimens in 7 (8%). From the patients that underwent conization, two (2.5%) were detected with LVSI. Five patients (7%) were found to have involved margins and from those, the majority was managed by a second conization. Mean follow-up time was 54 months (range: 30-110 months). Four patients (6.6%) with recurrence were observed during follow-up, all of them with LSIL. No cases of invasive disease or HSIL were encountered. CONCLUSIONS: Laser CO(2) conization is a safe and effective mode of treatment for women suffering from MIC and wish to retain their fertility. However, this type of management should be advocated only in cases fulfilling the strict criteria for MIC as these have been defined by FIGO.

Adult↗

PubMed2001

Value of human papillomavirus deoxyribonucleic acid testing after conization in the prediction of residual disease in the subsequent hysterectomy specimen.

OBJECTIVE: Our aim was to evaluate human papillomavirus deoxyribonucleic acid testing after conization in predicting residual disease in the subsequent hysterectomy specimen. STUDY DESIGN: A prospective study was conducted on 75 patients with grade 3 cervical intraepithelial neoplasia who had cone margins or endocervical curettage specimens showing disease and who elected to undergo hysterectomy after conization. All patients underwent high-risk human papillomavirus deoxyribonucleic acid testing by the Hybrid Capture II (Digene Corporation, Gaithersburg, MD) system before conization and at the time of hysterectomy (within 2-7 weeks after conization). The presence of human papillomavirus deoxyribonucleic acid in cells obtained by endocervical brush before hysterectomy was correlated with residual disease in the hysterectomy specimens. RESULTS: Of the 92 patients enrolled, 75 were eligible. Of these 75 patients, 52 (69.3%) had persistent human papillomavirus deoxyribonucleic acid after conization, and 27 (36.0%) of the 75 patients had residual cervical neoplasia in the hysterectomy specimens. Those with negative results for human papillomavirus deoxyribonucleic acid after conization were all (23/23) without residual disease in the uterus (100% negative predictive value). All those who had residual disease (27/27) had positive results for human papillomavirus deoxyribonucleic acid at the time of hysterectomy (100% sensitivity). Postconization human papillomavirus deoxyribonucleic acid status (odds ratio, 4.000; 95% confidence interval, 1.531-10.449; P =.005) and grade of dysplasia after endocervical curettage (classified as grade 2 cervical intraepithelial neoplasia or less severe disease vs grade 3 cervical intraepithelial neoplasia: odds ratio, 6.612; 95% confidence interval, 2.837-15.409; P =.0002) were significantly associated with residual tumor in the uterus. CONCLUSIONS: This prospective study confirms an excellent sensitivity and negative predictive value of human papillomavirus deoxyribonucleic acid testing after conization in predicting residual cervical neoplasia. A strategy of managing patients with grade 3 cervical intraepithelial neoplasia, based on postconization human papillomavirus deoxyribonucleic acid findings and endocervical curettage results, is proposed.

Adult↗

PubMedDate not supplied

Cold knife conization and loop excision for cervical intraepithelial neoplasia.

AIMS AND BACKGROUND: Our aim was to investigate whether loop excision is an acceptable alternative to traditional cold knife conization of the cervix. PATIENTS AND METHODS: 240 with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 120) or cold knife conization (n = 120). Success and complication rates of both methods were analysed. RESULTS: 100% of cold knife conization and 98% of loop excision surgical specimens were positive for dysplasia. The rate of complete resection was 91% in the cold knife and 82% in the loop excision group, but histologic confirmation of residual CIN was obtained in only 2 (1.7%) women after cold knife conization and in 5 (4.2%) after loop excision. Loop excision cones were significantly shallower than those obtained by a cold knife. Secondary surgical procedures due to early hemorrhage were performed in 9 (7.5%) patients treated with cold knife conization and in 8 (6.7%) treated with loop excision. Elevated temperature postoperatively was observed in 16.4% of patients after cold knife conization and in 13.9% after loop excision. There were no other postoperative complications. CONCLUSIONS: The results suggest that cold knife conization and loop excision are comparable and equally effective diagnostic and therapeutic procedures for CIN.

Adult↗

PubMedDate not supplied

Cold-knife conization versus photodynamic therapy with topical 5-aminolevulinic acid (5-ALA) in cervical intraepithelial neoplasia (CIN) II with associated human papillomavirus infection: a comparison of preliminary results.

BACKGROUND: The optimal treatment of preinvasive cervical lesions is still not clear as all surgical techniques cause substantial cervical stroma destruction with the risk of a possible incompetent cervix. Photodynamic therapy can preserve fertility due to selective tissue destruction. The aim of the present study was to compare the efficacy of cold-knife conization versus photodynamic therapy with topical 5-aminolevulinic acid in eradicating cervical intraepithelial neoplasia (CIN) II and associated HPV infection. PATIENTS AND METHODS: Eleven HPV-positive non-pregnant women were selected for photodynamic therapy (PDT). To be eligible for this procedure superficial cervical PAP smears as well as colposcopic biopsies performed before therapy had to show CIN II with the lesion involving at least 15% of the cervix and being colposcopically visible. The deep endocervical PAP smear had to show normal endocervical epithelium. The next (following each PDT) 11 HPV-positive women with CIN II treated with cold-knife conization were used as a control group. The cervical sampling for HPV DNA was performed 3 months after conization and PDT. Patients were followed-up for 1 year with cytological smears and colposcopy at the outpatient department of the hospital. RESULTS: Follow-up at three months revealed that HPV was eradicated by both techniques in 73%. After 12 months follow-up, 100 vs. 91% (conization vs. PDT) of the patients were disease-free. No systemic side-effects and no local necrosis, sloughing or scarring occurred due to PDT. One patient treated with PDT presented with a relapsing suspicious PAP smear and an abnormal white colposcopic lesion after application of acetic acid 6 months post-PDT. A subsequent conization was performed and revealed a CIN I lesion. No statistically significant differences concerning HPV eradication (p > 0.05) and recurrence (p > 0.05) could be observed between the two methods. CONCLUSION: The results presented in this study indicate that topical PDT with 5-ALA is in most cases a successful treatment of CIN II with comparable results to cold-knife conization. In contrast to cold-knife conization, PDT causes no substantial cervical stroma destruction with the risk of a possible subsequent incompetent cervix. Also the feasibility of topical PDT on an outpatient basis, the lack of significant post-treatment complications and the cost effectiveness make the topical approach with PDT preferable in selected circumstances. Due to the potential risk of invasive cancer with metastatic spread, patient's selection criteria must be strict and a pretreatment histological examination is obligatory.

Adult↗

PubMed1997

Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease.

OBJECTIVE: To determine the interpretability and significance of the traditional factors used to predict residual dysplasia in hysterectomy specimens after loop conization. MATERIALS AND METHODS: Loop electrosurgical cervical conization was performed on 372 patients. Ninety three women had a hysterectomy within 6 months of the loop conization. Residual disease was defined as cervical intraepithelial neoplasia or cancer in the hysterectomy specimen. RESULTS: Of the 93 patients having a subsequent hysterectomy, 36 (38.7%) has residual disease in their hysterectomy specimen. The mean age of the patients with residual disease in the post loop conization hysterectomy specimen was 42.22. The mean age of those free of residual disease was 29.42. By multivariate analysis, dysplasia involving the ectocervical margin (p = 0.34) and the endocervical margin (p = 0.35) was not predictive of disease in the hysterectomy specimens. Endocervical curettage (p = 0.005), glandular involvement (p = 0.01), loop conization pathology findings (p < 0.05) and cytological examination (p < 0.001) were predictive of residual dysplasia. CONCLUSIONS: Cytological reports, increasing age, severity of disease, gland involvement and endocervical curettage were the only factors that accurately predicted residual dysplasia. The presence or absence of dysplasia in the loop conization, ectocervical margin and endocervical margin was not predictive of residual dysplasia in post loop conization hysterectomy specimens.

Adult↗

PubMed1991

Conization for CIN associated with human papillomavirus infection.

We report results of follow-up by PAP smears and colposcopy in 116 women treated since 1981 by conization for cervical intraepithelial neoplasia with human papillomavirus infection (HPV-CIN). The mean follow-up time was 31.9 (SD 19) months. Preoperative diagnosis was HPV-CIN II (with extension into the endocervix) in 11 cases and HPV-CIN III in 103 cases; two diagnostic conizations were performed. The histological examination of the cone biopsies showed complete excision of CIN in 109 cases (94%). Three patients underwent hysterectomy after conization; one had microinvasion in the cone biopsy, one had suspicion of microinvasion and one had non-radical conization. Three patients (2.6%) were lost to follow-up. After excluding these six patients the primary cure rate of HPV lesions (normal cytological and colposcopical finding after conization) was 82.7%. Four patients (4.6%) had residual CIN after conization. During the follow-up 15 patients had recurrence of HPV infection, only one had HPV-CIN I. HPV 16 was the most common HPV type (56/116, 48.2%) in the conization group and also in the recurrent cases (9/15, 60%). The results support the role of HPV 16 in cervical carcinogenesis.

Adult↗

PubMed1979

Pregnancy complications following conization of the uterine cervix (I).

The literature on the course of pregnancies following conization of the uterine cervix has been studied. It is demonstrated that an evaluation of the possible effect of conization upon subsequent pregnancy should be based upon a comparison of either pregnancies before and after conization or upon a comparison between pregnancies in women with a previous conization and in a control group of women without conization. In both cases the possible influence of conization can be evaluated only if the patient material is described as regards age, parity, number of previous pregnancies, smoking habits, etc., factors which may all influence the course of pregnancy. None of the previous publications have described the patient material sufficiently, and most studies have not tried to set up control groups. Due to these deficiencies we do not find it justified that conization leads to reduced fertility, increased frequency of spontaneous abortion, nor to increased perinatal mortality. An increased prematurity rate may not be rejected, however, but this point has not been adequately evaluated in the previous papers.

Abortion, Induced↗

PubMed1981

Severe cervical dysplasia. Control by biopsies or primary conization? A comparative study.

During the period 1967-75 severe cervical dysplasia was diagnosed in 87 consecutive cases by means of colposcopically directed biopsies of the portio and by cervical curettage. Thirty-eight of the patients were treated, 3-6 weeks after diagnostic biopsy, by conization (conization group) and subsequently followed with smears and colposcopy. The remaining 49 patients (the biopsy group) were followed up at regular intervals by colposcopically directed biopsies of the portio and cervical curettage. The follow-up period for all 87 patients ranged from 9 to 106 months, mean 47.6 months. The groups were comparable with respect to the most important epidemiological factors. During the follow-up period progression to carcinoma in situ and to microinvasive carcinoma was found in 57.1% of the biopsy group but in 0% of the conization group. Of the whole material, 69 patients had conization (the 38 patients of the conization group plus 31 of the biopsy group). In 3 cases (4.35%) the cone diagnosis was 1 grade more serious than the biopsy diagnosis. The mean transit time of progression from severe dysplasia to CIS/MIC was 12-15 months. It is concluded that severe dysplasia is a rapidly progressing state which can be safely diagnosed by colposcopically directed biopsies of the portio and cervical curettage and effectively treated by conization. In view of the fact that not less than 32.7% of the cases with severe dysplasia in the biopsy group regressed during follow-up, we recommend that the diagnosis be established by portio biopsies and cervical curettage, twice with an interval of 3 months to restrict the number of superfluous conizations.

Biopsy↗

PubMed2001

Negative predictive value of human papillomavirus test following conization of the cervix uteri.

OBJECTIVE: The goal of this study was to determine/evaluate the negative predictive value of human papillomavirus (HPV) testing following conization of cervix uteri. METHODS: A prospective analysis was undertaken on 79 cone biopsies of women with high-grade lesions (cervical intraepithelial neoplasia (CIN) III). HPV testing was performed on cervical smears before and after conization. We correlated the margin status (defined as positive cone margin or endocervical curettage status) and positive conization HPV status with the residual disease in a hysterectomy specimen. A Digene II kit was used to perform HPV testing. HPV detection was done by Hybrid Capture assay. RESULTS: Of the 79 patients, 47(59.5%) had positive margins after conization. HPV testing was positive in 37 cases (78.7%) and negative in 10 cases (21.3%). Residual disease was found in 31 of 47 (66%) postconization hysterectomy specimens. No residual lesions were found in HPV-negative cases. Of the 32 cases with negative margins following conization, HPV testing was negative in 25 cases (78%) and was positive in 7 cases (22%). Among these 25 cases with negative HPV tests, no residual lesion was detected, and in 7 HPV-positive cases, only one residual lesion was found. CONCLUSION: HPV testing is potentially an effective tool in predicting residual dysplasia after conization and could potentially assist in the decision between hysterectomy and conservative follow-up in women with CIN III.

Cervix Uteri↗