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PubMed1998

Management of cervical intraepithelial neoplasia of the uterine cervix: 110 cases treated by cold-knife conization.

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate treatment by cold-knife-conization in women carriers of cervical intraepithelial neoplasia (CIN). METHODS: The histologic findings of pre-clinical neoplasia of the cervix after conization were compared to the previous findings of cytology, colposcopy and punch-biopsy in 110 women examined between 1985 and 1995. The chi square test (chi2) was used for the statistical analysis. RESULTS AND CONCLUSIONS: A close correlation is clinically important where complementary roles of these three methods are used to identify lesions suitable for local ablative therapy. The Pap test alone is no longer sufficient for the screening of the pre-cancerous lesion of the cervix and colposcopy is compulsory each time the smear is inadequate or altered. Conization permitted us to single out 13 (11.8%) cases of carcinoma. After cold-knife conization we had six (5.4%) recurrences within two years and two (1.8%) within three years. Our data show that conservative therapy by conization in women with CIN reduces the risk of invasive cancer of the cervix but careful follow-up of these patients is essential.

Adult↗

PubMed1976

Carcinoma-in-situ of the cerivix treated with colposcopy guided epithelial conization. Report of a 4-7 year follow-up study.

Twenty-five patients with the diagnosis of carcinoma-in-situ (CIS) of the cervix were treated with colposcopy guided epithelial conization. During the follow-up study of 4-7 years' duration, there was no recurrence of CIS in 20 of the 25 patients. Between 6 and 12 months after conization, 3 patients showed recurrence of CIS. Two of these patients were treated with further epithelial conization with no evidence of further recurrence 4 years after the second treatment. The third patient refused to accept further epithelial conization and modified radical hysterectomy was done without any evidence of residual tumour in the hysterectomy specimen. One patient showed stromal invasion in both colposcopically guided biopsy and bone biopsy. Modified radical hysterectomy specimen showed remnants of stromal invasion. One patient with Class IV smear failed to show any atypical transformation zone and cervicitis was proven on colposcopy guided biopsy following treatment with Flagyl. For two of the 25 patients, cytology was Class II and therefore failed to diagnose the pre-malignant condition; but colposcopy showed a grade 3 atypical transformation zone and the presence of CIS was confirmed histologically. Simultaneous use of cytology, colposcopy and colposcopically guided biopsy confirmed the diagnosis of CIS in all cases. The authors recommend colposcopically guided epithelial conization in younger patients, provided the malignant lesion is strictly intra-epithelial, and limited to the ectocervix. Routine follow-up with the aid of cyto-colposcopy remains the key factor in this schedule of therapy.

Adult↗

PubMed1993

Cervical conization as definitive therapy for early invasive squamous carcinoma of the cervix.

Young women who present with stage Ia carcinoma of the uterine cervix may strongly desire preservation of fertility. There is little published information on the outcome of patients treated for early invasive cervical cancer with cervical conization. Patients were considered eligible for conservative management if they had a squamous lesion invading to a depth less than or equal to 3 mm with no lymphatic or vascular space involvement and negative margins. We identified 14 patients who had been treated by cervical conization alone for early invasive carcinoma of the cervix. Pathologic variables were reviewed for all patients. Patient records were retrospectively reviewed for demographic, pathologic, and follow-up information. The mean depth of invasion was 1.6 mm (range, 0.5-2.8 mm). The mean number of cone sections evaluated was nine (range, 6-13 sections). The median follow-up period following conization was 26.5 months (range, 1-170 months). One patient underwent subsequent hysterectomy and was found to have mild dysplasia. Thirteen patients have retained their uteri and none has developed recurrent invasive or preinvasive lesions. We conclude that cervical conization is an acceptable therapy for selected cases of microinvasive squamous carcinoma of the uterine cervix. Larger studies of this patient group are indicated to confirm the safety of conization as definitive therapy in selected cases of early invasive cervical carcinoma.

Adult↗

PubMed1994

Cold-knife conization versus loop excision: histopathologic and clinical results of a randomized trial.

Ninety patients with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 38) or cold-knife conization (n = 52). All specimens were well evaluable at histology. The average width of the lesions at histology was 10.2 and 9.7 mm, respectively (ns). The average weight of the specimens was 2.6 and 5.6 g (P < 0.01) and the average depth was 9.2 and 15.8 mm (P < 0.01), respectively. The distance between the cervical resection margin and CIN was 14 mm after loop excision and 24 mm after cold-knife conization (P < 0.06). The margins of the specimen were not clear of disease in 8 patients after loop excision and in 12 patients after conization (ns). Two patients after loop excision and in three patients after cold-knife conization had postoperative bleeding. The results suggest that, compared with cold-knife conization, loop excision removes less healthy tissue without reducing the chances for cure.

Adult↗

PubMed1985

The outcome of pregnancy and preterm delivery after conization of the cervix.

Of 607 women who had undergone conization of the cervix in 1973-1980 in the country of Funen, Denmark, 128 women had completed a total of 166 pregnancies before April 1, 1982. There was apparently no adverse effect of conization on these pregnancies. The frequency of delivery before 37 completed weeks of gestation, of a birthweight less than 2500 g or below the 10th percentile did not differ from that for a population standardized for age and parity. Five women had a second trimester abortion in a pregnancy after conization, but without evidence of cervical insufficiency. Eleven conized women had a caesarean section in a subsequent pregnancy for reasons unrelated to conization.

Adult↗

PubMed1982

Pregnancy following cervical conization.

The effect of cone biopsy for cervical intraepithelial neoplasia on subsequent fertility and pregnancy was evaluated for 314 reproductive age women. Excluding patients lost to follow-up and those who had therapeutic hysterectomy, two study groups totaling 166 patients were obtained. The first consisted of 105 patients who did not become pregnant following conization. We found no evidence of secondary infertility caused by cervical conization. The second group of 61 patients achieved 88 pregnancies following conization. Comparison of these pregnancies with the outcome of 106 pregnancies by these same women prior to conization showed no effect of the operation on spontaneous abortions, preterm delivery, or cesarean section rates. The sole sequela of conization was to alter the duration of the first stage of labor.

Abortion, Spontaneous↗

PubMed1993

Immunohistochemical studies of the uterine cervix after CO2 laser conization.

OBJECTIVE: To investigate the process of the maturation of cervical epithelium after CO2 laser conization. METHOD: Specimens from the uterine cervix (248) resected from 31 premenopausal females who had hysterectomy after CO2 laser conization were studied with 2 kinds of anti-keratin monoclonal antibodies (PKK-1, KL-1). RESULT: (i) The epithelium covered stroma after 4-6 weeks. (ii) In the normal S-C junction, KL-1 was localized to the middle and upper layers, and PKK-1 to the basal layer. (iii) The staining patterns of KL-1 and PKK-1 in the S-C junctions after conization could be classified into 4 groups according to localization and staining intensity. (iv) The S-C junction appeared normal in all specimens 7 weeks after conization. CONCLUSION: The regenerating epithelium covered the stroma within 4-6 weeks, but resolution of squamous epithelial metaplasia only occurred 7 weeks after conization.

Adult↗

PubMed1982

Postoperative morbidity in cases of cervical conization followed by vaginal hysterectomy.

In an attempt to define a group of patients at risk for relatively increased morbidity who have had vaginal hysterectomy after conization, we retrospectively analyzed patients who had hysterectomy for cervical intraepithelial neoplasia. Patients who had hysterectomy within 24 hours of conization had an overall morbidity rate of 42% and are compared to a second group of patients who had hysterectomy six weeks or more after conization, with a morbidity rate of 24%. A third group of patients who had hysterectomy without conization had an overall morbidity of 19%. These data suggest that a period of less than 24 hours from conization to hysterectomy, particularly in large teaching hospitals, leads to relatively greater morbidity.

Cervix Uteri↗

PubMed1982

Outcome of pregnancy after conization.

The outcome of 635 pregnancies in 197 women before and after conization is reported. After conization a significant increase in premature deliveries occurred in young women (age 21-25), nulliparae representing the highest risk. The rate of premature deliveries in this age group was 4.4% before conization and 30.6% after conization. No such increase could be found in any other age group. Labor was notably short in non-parous women and in parous women it started with rupture of the membranes significantly more often after conization. In addition, a significant increase in the frequency of cervical stenosis was observed, but this was of clinical significance in only one case. Treatment in the form of prophylactic cerclage did not reduce the incidence of either premature delivery or of late spontaneous abortion.

Abortion, Spontaneous↗

PubMed1992

Conization with a carbon dioxide laser as a uterine-preservation operation for patients with preinvasive cervical carcinoma.

Preinvasive cervical carcinoma (PCC) is a disease entity of the uterine cervix resulting from carcinoma in situ and various degrees of dysplasia. These cases are conventionally treated by a total abdominal hysterectomy. Effective management that can preserve the uterus is more desirable than hysterectomy. In this report, we present the results and complications of laser conization as a uterine-preservation treatment. At our dysplasia clinic, cases of reproductive age diagnosed with PCC can voluntarily undergo laser conization. From June 1985 to May 1988, there were 26 cases who received this treatment. After treatment, they were regularly followed up for more than three years. Before and after surgery, these cases were evaluated by a Pap smear for cytology, colposcopy, a cervical punch biopsy and endocervical curettage for histopathology. Eighteen cases with a satisfactory colposcopy were treated by laser vaporizing conization. Eight cases with an unsatisfactory colposcopy were treated by laser excisional conization. Their mean age was 35.8 (SD 7.7) years, and parity was 1.5 (SD 0.9). The instrument used was a Sharplan CO2 laser model 720. The power density was around 1,000 W/cm2 for vaporization, and 1,500 W/cm2 for excisional conization. During the operations, there was little bleeding. No case required a blood transfusion. The vaginal discharge decreased within four days after treatment. The cervical epithelium on the operated wound began growing after the second week, and the cervix healed well in four to six weeks. After healing, the squamocolumnar junction in each case was visible on colposcopy. No case suffered from cervical stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Rational use of cryosurgery and cold knife conization for treatment of cervical intraepithelial neoplasia.

In recent years a variety of conservative treatment modalities are being used to remove Cervical Intraepithelial Neoplasia (CIN). A series of 568 cases of patients affected by CIN, detected in our Department over a period of 10 years and treated following a balanced use of colposcopy guided cryosurgery and cold knife conization, has been reviewed. One-hundred-fifty-three patients, 111 with CIN 1 and 42 with CIN 2, were treated by the use of a nitrous oxide cryoprobe. The remaining 415 patients underwent cold knife conization, under general anesthesia and hospitalization. Routine follow-up for all cases included cytology, colposcopy and aimed biopsy when required. Cryotherapy had a success-rate of 90.1% (CIN 1-CIN 2 only) and "complete" conization 94.6% (included CIN 3 cases). Complications of conization, such as late haemorrhage and cervical stenosis, were more frequent with the "open technique" than the "suture technique". Nine pregnancies after cryotherapy and 34 after conization have been reported, no significant differences were noted in the pregnancy outcome following either treatment.

Adult↗

PubMed1991

Discrepancy of cervical cytology and colposcopic biopsy: is cervical conization necessary?

The purpose of this study was to determine whether diagnostic cervical conization is necessary in the patient with a discrepancy between the Papanicolaou smear and the colposcopically directed biopsy(s). Patients eligible for the study had at least a two-degree discrepancy, eg, CIN III cytology and CIN I or less on colposcopic biopsies, or CIN II cytology with biopsies showing no dysplasia. Of the 786 records reviewed, 87 (11.1%) had such a discrepancy. Twelve of 87 patients (13.8%) were pregnant and ten of 87 (11.5%) failed to return after their initial colposcopic evaluation, leaving 65 patients in the study group. Of these, 20 of 65 (30.8%) were treated medically, nine (13.8%) had cryotherapy, and 36 (55.4%) underwent diagnostic cervical conization. Of patients undergoing cervical conization, three had microinvasive carcinoma of the cervix. Following medical therapy, only two of 20 patients (10%) had negative cytology, two (10%) had CIN I, five (25%) received additional therapy, and 11 (55%) were lost to follow-up. Seven patients did not return for follow-up Papanicolaou smear after medical treatment, and four did not return after their initial posttreatment Papanicolaou smear revealed persistent dysplasia. Of the nine patients treated with cryotherapy, six (66.7%) had a negative Papanicolaou smear at the time of their initial follow-up. The results of this study emphasize the importance of proceeding with diagnostic or therapeutic conization if a two-stage or greater discrepancy exists between the colposcopically directed biopsies and the cervical cytology. The risk of not diagnosing a microinvasive or invasive cervical carcinoma far outweighs the risk of conization.

Biopsy↗

PubMed1990

Cold-knife and laser conization for cervical intraepithelial neoplasia.

In a 5-year study, 425 women had conization performed for cervical intraepithelial neoplasia (CIN) I, II or III. Conization was performed only in cases of positive endocervical curettage or when colposcopy was inconclusive. In all other cases, local destruction was the operation of choice. In the early years of the study, conization was done by the cold-knife method (N = 201), whereas CO2 laser was used in the latter part of the study (N = 224). Success and complication rates were the same for the two methods. Abnormal cytology after conization was found in a total of 53 cases (12.5%), but a histologic confirmation of residual or recurrent CIN was made in only 27 women (6.4%). This corresponds to a success rate of 92% after cold-knife and 95% after laser conization. The CIN grading of the residual or recurrent CIN was similar to or less than the CIN diagnosis of the cone. Because our success rate was comparable to that of other series with much less strict referral criteria, our policy seems adequate.

Carcinoma in Situ↗

PubMed1985

Conization of the cervix with the CO2 laser as an office procedure.

Conization of the cervix is usually done under general anesthesia in an operating room. The use of the CO2 laser has been shown to reduce the high morbidity associated with cervical conization, but, like cold-knife conization, laser excisional procedures are still usually done in an operating room under general anesthesia. Forty-one patients underwent conization of the cervix with the CO2 laser in an office setting. The procedure was well tolerated, and intraoperative bleeding was not a problem. Two cases of delayed postoperative bleeding were treated on an outpatient basis. The ability to perform cervical conization in an office setting offers significant advantages.

Adult↗

PubMed1982

Correlation of perioperative morbidity and conization to radical hysterectomy interval.

Between October 1969 and December 1980, radical hysterectomies were performed on 311 patients at the University of Alabama Medical Center in Birmingham. The hospital records of these patients were reviewed for perioperative morbidity. One hundred twenty-two patients (39.2%) had had previous cold knife conization. The conization to radical hysterectomy interval varied between 48 hours and 8 weeks. An analysis of the perioperative morbidity was performed comparing patients with to those without prior conization. Previous cervical conization, regardless of the interval, was not associated with increased hospital stay, operative time, blood loss, or febrile morbidity in patients undergoing radical hysterectomy. These findings suggest that a radical hysterectomy may be safely performed after cervical conization, regardless of the intervening interval.

Abscess↗

PubMed1982

The frozen section analysis of conization. A reappraisal of the ends and means.

A retrospective review of 163 consecutive conizations of the cervix is reported to analyze the use of frozen section interpretation of the conization specimen in 115 patients. There were no failures to identify occult invasive cancer on the initial frozen section analysis and no differences of therapeutic significance when the permanent sections were reviewed. The frozen section conization-immediate hysterectomy technique was compared with the clinical course of 29 patients whose hysterectomy was delayed for 6-8 weeks after conization. The total operating time, estimates of operative blood loss, amount of blood required in transfusion, and morbidity were similar in both groups. Total hospital days were significantly decreased with the cone/frozen section/immediate hysterectomy technique. Because frozen section conization/immediate hysterectomy offers additional advantages of a single hospital admission, single anesthetic induction, and single postoperative recovery/convalescent period, this approach continues to deserve serious consideration in the management of patients with CIN when conization is necessary and subsequent hysterectomy is desired.

Adult↗

PubMed1982

Colposcopy, conization, and hysterectomy practices: a current perspective.

Data from the provincial cytology program has shown a progressive increase in the number of cases of cervical carcinoma in situ detected in the general population and a doubling of disease rate in third decade women, with most of the cases now in the 25- to 29-year-old age group. The introduction of a colposcopy service has led to a significant decrease in the number of diagnostic conizations performed over a 5-year period. Conization was still used for therapy in a substantial number of women despite the availability of cryotherapy and laser surgery. Eighty-five percent of all patients undergoing cone biopsy had sever dysplasia or carcinoma in situ (CIN III) on pathological examination. In 25% of patients, the conization specimen revealed either dysplasia or carcinoma in situ extending to resection margins. During review of 2249 patients, 1174 were spared a conization and were treated by either hysterectomy, cryotherapy, or laser surgery. It would appear that, although colposcopy can reduce dramatically the number of diagnostic cone biopsies, conization will still be required for therapy in a substantial number of patients.

Adult↗

PubMed1994

Hot-knife conization of the cervix: clinical and pathologic findings from a study introducing a new technique.

OBJECTIVE: To introduce an alternative method for conization of the cervix using a Teflon-coated hot knife and to evaluate thermal distortion, adequacy of excision, operating time, blood loss, and short- and long-term effects of this method. METHODS: Between 1987-1993, 88 patients underwent cervical conization using a Teflon-coated hot knife at temperatures ranging from 110-130C. Histopathologic slides were reviewed simultaneously by two pathologists, who assessed thermal distortion, adequacy of excision, and interpretability of the surgical margins. Clinical information was obtained prospectively, including operating time, blood loss, and depth and volume of the excised cone. In addition, data were accumulated retrospectively from 40 randomly selected patients who underwent cold-knife conization between 1985-1990. Short- and long-term data were assessed for healing and scarring and the adequacy of postoperative Papanicolaou smears in the hot-knife patients. RESULTS: Thermal injury was minimal, with 300 mu or less in 83 patients (92%) and 350-600 mu in four patients. One patient had thermal distortion of 1500 mu. All slides were interpreted adequately. Blood loss was mild to moderate in 84 of 88 patients (95%) in the hot-knife group and in 34 of 40 patients (85%) in the cold-knife group. No patient in the hot-knife group needed blood transfusion or hospitalization. Operating time was reduced by as much as 67% when the hot knife was used. Thirteen percent of the hot-knife patients developed stenosis of the external os. No patient in the hot-knife group developed recurrence within 2 years of surgery. CONCLUSION: Using a Teflon-coated hot knife for conization of the cervix produces adequate surgical margins and reduces blood loss and operating time over that with cold-knife conization. Long-term follow-up reveals no increase in cervical stenosis and demonstrates adequate cytologic smears in the hot-knife patients.

Adolescent↗