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PubMed1992

The relationship between prior cervical conization, cervical microbial colonization and preterm premature rupture of the membranes.

The occurrence of prior cervical conization and the cervical microbial colonization was investigated in 38 women with idiopathic preterm labor, 35 women with preterm premature rupture of the membranes (PPROM) and 75 normal pregnant women at 26-34 weeks of gestation. Data were analyzed by Fisher's exact test (two-tailed). The frequency of prior cervical conization was significantly higher in PPROM patients compared to normal pregnant women (P < 0.001) and to patients in preterm labor (P < 0.01). Lactobacilli occurred with a lower frequency in patients with PPROM compared to patients in preterm labor (P < 0.05) and control patients (P = 0.0543)-and with a lower frequency in patients with prior cervical conization (P < 0.05). All other microorganisms occurred with the same frequencies in all groups. The absence of lactobacilli may indicate changes in the cervical flora, which could increase the risk of PPROM. Prior cervical conization may impair the antimicrobial defense-mechanisms in the cervix, which could facilitate ascending microbial colonization. This may lead to a release of prostaglandins and proteolytic enzymes and subsequently preterm labor and rupture of the membranes.

Adult↗

PubMed1992

Human papillomavirus types and cervical squamous intraepithelial lesions that recur after cold-knife conization.

The purpose of this study was to analyze the HPV types and histological margins of cervical squamous intraepithelial lesions (SILs) treated by cold-knife conization and to correlate this with recurrent disease. Of 203 cone biopsies done for SILs primarily because the entire lesion could not be visualized at colposcopy, follow-up information was available for 85 cases. Of these 85 cases, biopsy-proven recurrences were documented for 10 (12%) women. In the SILs which recurred after conization, the lesion was noted on the surgical margin in 7/10 (70%) cases. In contrast, SILs that did not recur after cold-knife conization were detected on the surgical margin in only 12% of cases. In 7 of the recurrences, the HPV type detected in the pretreatment SIL was the same as that detected in the SIL that occurred after conization. In the other 3 recurrences, one of either the primary or recurrent SILs was HPV positive and the other corresponding lesion HPV negative. It is concluded that detection of a SIL on the surgical margin is a marker for recurrent disease and that recurrences are often associated with the same HPV type as that noted in the pretreatment SIL.

Biopsy↗

PubMed1998

Positive margins after cervical conization as an indicator of residual dysplasia.

Objective: To determine the significance of positive margins of resection after cervical conization as an indicator of residual dysplasia.Materials and Methods: A retrospective analysis for patients who underwent cervical conization either by loop electrosurgical excision procedure or cold knife conization between 1986 and 1997 at Montefiore Medical Center and North Central Bronx Hospital. The factors evaluated included grade of dysplasia with respect to positive or negative margins and post-procedure follow-up. Differences among groups were evaluated using the chi(2) and Fisher's Exact test.Results: Of a total of 179 patients, 99 had positive margins of resection and 80 had negative margins of resection. Twenty-six patients had CIN I, of which 10 had positive margins of resection and 16 had negative margins of resection. There were 30 patients with CIN II, of which 13 had positive margins and 17 had negative margins. One hundred fourteen patients had CIN III/carcinoma in situ (CIS), of which 68 had positive margins of resection while 46 had negative margins of resection. Nine patients had microinvasive disease (MIC), of which 8 had positive margins of resection and 1 had negative margin of resection. The correlation between higher grades of dysplasia and the likelihood of having positive margins was noted to be statistically significant (P =.02). Patients were followed up from a period of 6 weeks to 5 years.Of the patients with CIN I and positive margins, 5 had a normal post-cone Papanicolaou smear while 2 had an abnormal post-cone Papanicolaou smear. Seven of 9 patients with CIN II and positive margins had normal initial post-procedure Papanicolaou smear while only 2 had abnormal initial post follow-up Papanicolaou smear. Twenty-five patients with CIN III/CIS and positive margins had normal Papanicolaou smears at their initial post-procedure follow-up while 36 patients had an abnormal initial follow-up. Six of 8 patients with MIC and positive margins had documented follow-up. Of these 6, 2 had normal post-procedure Papanicolaou smears while 4 had abnormal post-procedure Papanicolaou smears. This approaches statistical significance. Additionally, the incidence of residual disease was analyzed in hysterectomy specimens with respect to grade of dysplasia. No patients with CIN I and positive margins were treated with hysterectomy. Of the 3 patients with CIN II treated with hysterectomy, 2 had residual dysplasia. Of the 21 patients with CIN II/CIS who underwent hysterectomy, 10 had residual disease. Of the 5 patients with MIC who underwent hysterectomy, 3 had residual disease.Conclusion: The likelihood of positive margins of resection increases with higher dysplasia. The incidence of abnormal initial post-procedure Papanicolaou smear appears to be increased with increasing grade of dysplasia. Interestingly, there does not appear to be an increase in the incidence of residual dysplasia when hysterectomy is performed for positive margin of resection after conization for high grade dysplasia.

Journal Article↗

PubMed1992

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)--a preliminary report.

OBJECTIVE: To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). DESIGN: A multicentre prospective cohort study. SETTING: CRC Clinical Trials Unit, Birmingham. SUBJECTS: 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. INTERVENTION/PROTOCOL: Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. MAIN OUTCOME MEASURES: Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. RESULTS: Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow-up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. CONCLUSIONS: Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Adult↗

PubMed1986

Conization by carbon dioxide laser or cold knife in the treatment of cervical intra-epithelial neoplasia.

In a randomized trial concerning 123 women with CIN, 59 were treated with laser conization under colposcope without further hemostatic remedy and 64 with cold knife conization guided by Schiller's iodine dyeing supported by side sutures, vaginal packing and postoperative oral administration of tranexam acid. Follow-up with colposcopy and cytology was done 3 and 12 weeks post-conization and then every 6 months. The average follow-up period was 36 months (28-48). Peroperative bleeding was rather less pronounced in the laser group. Postoperatively, however, bleeding requiring treatment was significantly less common in the laser group (5%) than in the cold knife group (17%). The recurrence rate of CIN was 7% in the laser group and 10% in the knife group. Stenosis of the cervical canal developed in 7% of the patients in the laser group and in 3.5% in the knife group. After 12 weeks the squamocolumnar junction was visible in its full extent in 66% of the laser treated patients compared with 38% of the cold knife treated patients. It is concluded that laser conization is a safe procedure even without hemostatic procedures other than the coagulation abilities of the laser beam itself, as used in this work.

Adult↗

PubMed1990

[The reproductive function in women with preinvasive and microinvasive carcinomas of the cervix uteri treated by conization].

An inquiry was carried out on 46 women with preclinical carcinoma of the uterine cervix, treated with conization at the gynecological clinic of the National Oncological Center. Women were at the age of 22 to 38 years. Conization was made on 8 women on account of microinvasive carcinoma with invasion up to 1000 mkm, but on 38 women--on account of carcinoma of 0 degree. 26 women became pregnant after conization but 9 of them performed induced abortion and 2-therapeutic abortion. Pregnancy of 5 women ended with spontaneous abortion during the first trimester, one woman waited for delivery and 9 women delivered on term and without interventions. One woman delivered twice. The first trimester was risky for women with preclinical carcinoma of the uterine cervix, treated with conization.

Abortion, Therapeutic↗

PubMed1990

[Clinical evaluation of the treatment of early cervical neoplasia by carbon dioxide laser conization].

One hundred twenty patients with cervical neoplasia were treated by conization, 78 with a carbon dioxide laser and 42 with a cold knife. Bleeding during the conization was 82.5 +/- 91.4 ml with the laser and 117.3 +/- 82.6 ml with the cold knife. The time required for the operation was 55.0 +/- 16.7 min and 37.7 +/- 10.2 min, respectively. With the aid of a local injection of epinephrine, peroperative bleeding was much less pronounced in the laser group (25.4 +/- 39.5 ml) and the time required for the operation was further shortened to 36.4 +/- 15.0 min. Six patients treated with the cold knife (14.3%) suffered postoperative hemorrhage requiring hemostasis, but only one in the laser series (1.3%). Forty-nine patients of 78 treated with the laser and 15 of 42 treated with the cold knife were subjected to conservative therapy. All of them were followed up by cytology, colposcopy and histology, and there was no failure or recurrence at either 8 weeks and 1 year after the operation. Unsatisfactory colposcopic findings developed in 9 patients (18.4%) in the laser group compared with 11 patients (73.3%) in the cold knife group. Specimens obtained after laser conization were satisfactory for use in histopathological evaluation. Conization with a carbon dioxide laser appears to be an acceptable procedure as a diagnostic method and conservative therapy for cervical neoplasia.

Adult↗

PubMed1989

[Usefulness of endometrial curettage during cervical conization].

In order to determine the value of uterine curettage at the time of cervical conization, as well as morbidity for it, 318 patients were studied. The patients were sent because of abnormal Papanicolaous's test. The established diagnostic procedures were cervical biopsy directed by Schiller's test and/or colposcopy and cervical cone. In 151 cases cervical cone was done without endometrial curettage, and in 167 endometrial curettage was used simultaneously to cervical conization. The results show that curettage plus cervical conization had a morbidity of 9.6%, statistically significant (p less than 0.05) as compared with cervical conization (4%). Furthermore, there was an RR 2.7 times of greater risk with the first procedure, morbidity increased and it did not contribute to a more complete diagnosis.

Adult↗

PubMed1989

[Studies on pregnancy after CO2 laser conization for cervical intraepithelial neoplasia].

One hundred and sixteen patients with cervical intraepithelial neoplasia were treated by CO2 laser excisional conization, from 1985 to 1987. All operations in this series were performed in the outpatient unit. 1) In this series, 83.6% (97 out of 116) were patients with CIN and 44.0% (51 out of 116) were patients under the age 39 who can be pregnant. 2) There was no remaining in the 16 materials out of 44 obtained by hysterectomy due to cervical dysplasia and carcinoma in situ (CIS). 3) In our series, 10.3% (6 out of 58) of the women with dysplasia or CIS (surgical margin negative) required two treatments respectively to eradicate their disease from 9 months to 16 months after laser conization. 4) None of 72 women developed postoperative cervical stenosis and cervical infection. 5) Much of the epithelial cover, although originating from columnar cells, became squamous epithelium by 28 days. 6) There were 5 pregnancies in 72 patients, from 5 months to 13 after laser conization. From our studies, a CO2 laser conization for treating CIN preserved the architecture of the cervix, permitting adequate colposcopic and cytological follow-up, and preserved cervical function, so that fertility is not affected and so that there is no interference with pregnancy.

Adult↗

PubMed1988

Comparison between lysine vasopressin and a long-acting analogue (N alpha-triglycyl-lysine vasopressin) used as local hemostatic agents for conization.

Lysine vasopressin and a long-acting analogue N alpha-triglycyl-lysine vasopressin were compared in a prospective randomized double-blind study including 71 women undergoing cold knife conization of the uterine cervix. Hemodynamic and hemostatic variables were studied. N alpha-triglycyl-lysine vasopressin had the following advantages over lysine vasopressin: it gave significantly less skin pallor, becoming evident at a later stage during the operation. The diastolic blood pressure was significantly lower, as also was the incidence of postoperative hemorrhages. Factor VIII related antigen was lower. On the other hand reduction in heart rate (values before conization compared with values during conization) was more pronounced when N alpha-triglycyl-lysine vasopressin was used, but there was no difference in absolute values between the two groups during conization.

Cervix Uteri↗

PubMed1987

Endometrial and endocervical curettage findings at the time of cervical conization.

The medical records and histopathology of 250 patients who underwent cervical conization between January 1979 and December 1982 were reviewed. Two hundred thirty (92%) had endometrial curettage at the time of cervical conization. Abnormal findings were present in 7 (3%) of the 230 curettings. Limiting the performance of endometrial curettage at the time of conization to patients meeting specific criteria would have reduced the number of combined procedures by 75% without jeopardizing our ability to detect significant pathology. Endocervical curettage was performed on 221 (88%) of the 250 patients undergoing conization. The endocervical curettings were not a good predictor of the involvement of the cone margins with neoplasia. Only 7 (20%) of 35 patients with involved endocervical margins had a positive endocervical curettage. While the cone margins predicted residual carcinoma in the hysterectomy specimen with a sensitivity of 1.0, the sensitivity of the endocervical curettings for predicting residual carcinoma was 0.5. Although endocervical curettings can detect an invasive cancer not detected in the cone specimen, a negative endocervical curettage does not rule out invasive cancer above the excision line.

Adult↗

PubMed1985

Outpatient cervical conization with the CO2 laser.

Ninety-six patients with grade 3 cervical intraepithelial neoplasia (CIN) were treated with CO2 laser conization, and 45 were treated with cold-knife conization. Local anesthesia was used in 83% of the patients in the laser group; the rest received general anesthesia. In the laser group seven patients developed peri- and postoperative hemorrhages. Hemorrhages occurred among four of those treated with cold-knife conization. Laser conization with local anesthesia was well tolerated and can be recommended as an outpatient procedure for patients with endocervical grade 3 CIN or lesions suggestive of microinvasive cancer.

Adult↗

PubMed1979

Radical hysterectomy: influence of recent conization on morbidity and complications.

From 1956 through 1975, 610 radical hysterectomies with pelvic lymphadenectomy were performed at the Mayo Clinic. Eighty-eight of these operations were done after conization of the cervix: 7, within 7 days; 74, between 8 and 28 days; and 7, on or after the 29th day. Operative febrile morbidity was not increased in the patients who had conization, and they also required fewer blood transfusions than the patients without previous conization. Incidences of all postoperative complications except pulmonary embolism were lower in the patients with cone biopsy than in those without. Of the 88 patients, 77% received antibiotics prophylactically during the operative period. There appeared to be no serious contraindications to performing radical hysterectomy and pelvic lymphadenectomy at any interval after diagnostic conization of the cervix.

Adenocarcinoma↗

PubMed1984

Use of an antifibrinolytic agent (tranexamic acid) and lateral sutures with laser conization of the cervix.

One hundred forty patients who underwent laser conization and 220 patients who underwent laser miniconizations were prospectively randomized into two study groups. One treatment group was given antifibrinolytic therapy in the form of tranexamic acid (Cyklokapron, KabiVitrum, Sweden) intraoperatively and for 14 days postoperatively. The other group did not receive antifibrinolytic therapy. In the group of 68 patients with laser conizations who were given antifibrinolytic therapy, no postoperative hemorrhages occurred, whereas there were eight such hemorrhages in 72 conizations (11%) in the untreated patients. This difference is statistically significant (P = .004, Fisher exact test for two proportions). Also, for laser miniconization, the frequency of postoperative hemorrhage was almost halved, from 9.1% in 110 patients not receiving antifibrinolytic therapy to 5.5% in the 110 treated patients. The use of lateral cervical sutures did not reduce the frequency of postoperative hemorrhage at laser conization in the present study.

Carcinoma in Situ↗

PubMed1984

Pregnancy outcome after combined amputation and conization of the uterine cervix.

The outcome of 109 pregnancies after combined amputation and conization of the uterine cervix for CIN was compared with 204 previous pregnancies of the same 84 women. Late spontaneous abortion and preterm delivery occurred significantly more often after the operation than before it (p less than 0.001). The occurrence of early abortion was equal in both groups. The rate of legal pregnancy termination of the postconization pregnancies increased with the age of the women at the time of conization. The rate of caesarean sections (25.5%) in conized patients was significantly higher (p less than 0.05) than the mean section rate in the clinic (14.6%) during the study period. One fourth of them were done for chorion-amnionitis suggesting cervical incompetence in these cases. However, prophylactic second trimester cerclage did not improve the prognosis of postconization pregnancies. Combined amputation and conization seems to be a significant risk factor in subsequent pregnancies requiring careful supervising of the patients.

Abortion, Spontaneous↗

PubMed1981

Conization for cervical dysplasia and carcinoma in situ: long term follow-up of 1013 women.

1013 women were treated with cold knife conization. Histopathological investigation of the cone biopsies revealed 169 with dysplasia, 718 with carcinoma in situ (CIS) and 26 with invasive carcinoma. Invasive carcinomas were found even in patients with the lowest degree of cytological abnormality. In 100 cases, no pathological changes were found. The majority of patients were followed for more than five years after conization. The longest period of follow-up was 17 years. In 98% of the women with various degrees of cervical dysplasia (including all severe dysplasias) the cytology returned to normal after conization. The corresponding figure for women with CIS was 90%. This figure depended on whether the resection margins of the cone were free from pathological epithelium. If they were free, 92% of the women had normal cytology at follow-up. However, if the margins were doubtful, the cytology returned to normal in 64%. All patients with marginal growth had a pathologic smear at follow-up. Most abnormal smears developed within the first year. If smears were negative the first year after conization for CIS with free margins of resection, the risk of developing severe dysplasia or CIS was 2.3%.

Adult↗

PubMed1993

Management of patients with positive margins after cervical conization.

OBJECTIVE: To evaluate conservative management of patients undergoing cervical conization with cone margins positive for dysplasia. METHODS: The outcomes of 93 patients with cone biopsies that had margins positive for dysplasia were tabulated. RESULTS: Thirty of 47 patients (64%) undergoing conization only and followed by cytology had negative Papanicolaou smears for at least 2 years. Twenty-one of 37 women (57%) with conization and immediate hysterectomy had no residual disease in the cervix. Three of nine women (33%) with conization and delayed hysterectomy had no detectable dysplasia in the remaining cervix. There was no case of progression to invasive disease. The overall resolution rate was 58%. Persistence of disease was found most often at the endocervical margins associated with cervical intraepithelial neoplasia grade III. CONCLUSION: Patients with cone margins positive for dysplasia can be followed appropriately with cytology. In cases of recurrent abnormal Papanicolaou smears, colposcopy, biopsies, and endocervical curettage should be repeated.

Adult↗

PubMed1997

Long-term follow-up of cervical intraepithelial neoplasia treated with minimal conization by carbon dioxide laser.

BACKGROUND AND OBJECTIVE: Minimal conization with carbon dioxide laser (CO2) for safe diagnosis and treatment of cervical intraepithelial neoplasia (CIN) 1-3 has been utilized for 15 years. To evaluate the results of 15 years' follow-up. STUDY DESIGN/MATERIALS AND METHODS: Clinical prospective study: 2,903 non-pregnant women whose cervicovaginal smear revealed CIN 1-3, confirmed by colposcopy, were referred for minimal conization treatment (LMC). This outpatient free-hand excision is performed under local anesthesia with a 60-W continuous laser beam focused to a 0.1-mm spot size, giving a power density of 165,000 W/cm2. Adjuvant cervical curettage is done routinely. RESULTS: Complications after the procedure were insignificant. Histopathological investigations revealed invasive carcinoma in 1.2% of the minicones. The primary cure rate was 96.1%. In the life table analysis of the patients the cumulative risk of recurrence for all forms of CIN was 0.89% at year 5, 1.36% at year 10, and 3.02% at year 15. There was no sudden onset carcinoma during the follow-up period. CONCLUSION: Minimal conization is a safe, effective treatment for CIN and early forms of microinvasive carcinoma. Invasive carcinoma can be detected early and should be treated without delay. The cumulative risk of developing new CIN is 3.02% at year 15 and there is no risk of sudden-onset invasive carcinoma following this procedure.

Adolescent↗