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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↗

PubMed1997

Outcomes after cervical cold knife conization with complete and incomplete excision of abnormal epithelium: a review of 699 cases.

A retrospective analysis was undertaken of 699 cone biopsies performed at the Royal Women's Hospital in Melbourne from 1966 to 1992. In 572 cases (82%), abnormal epithelium was assessed as having been completely excised, and in 127 (18%) excision was incomplete. There were no significant differences in age, parity, cytology, histology, or indications for conization between patients in whom excision was incomplete and those in whom complete excision was achieved. Of the patients whose cone biopsy histology showed complete excision of abnormal epithelium, 96.7% were found to have been cured of disease on the basis of normal follow-up or normal histology of hysterectomy specimens. The overall cure rate after incomplete cone biopsy was found to be 77%, but was influenced by the site of incomplete excision. The cure rate for incomplete excision at the ectocervical margin was 86%; incomplete excision at the endocervix was 68% and only 40% if excision was incomplete at both edges. Cone biopsy undertaken for cervical intraepithelial neoplasia is likely to be curative when the lesion is completely excised, but recurrent disease may occur and adequate follow-up is an essential part of patient management after conization, regardless of histological findings in the conization specimen. Most cases of incompletely excised cervical intraepithelial neoplasia will also be cured, especially if the incomplete margin is ectocervical, and cytological and colposcopic follow-up may be an acceptable alternative to repeat cone biopsy or hysterectomy in the management of such cases.

Adolescent↗

PubMed1999

The efficacy of cervical conization in the treatment of cervical intraepithelial neoplasia in HIV-positive women.

OBJECTIVE: The aim of this study was to evaluate the efficacy of cervical conization in the treatment of CIN in HIV-positive women. MATERIALS AND METHODS: Sixty-six HIV-positive women treated with cervical conization for CIN were stratified into four groups based on surgical margin and endocervical curetting (ECC) status (group 1: -margin/-ECC, group 2: +margin/-ECC, group 3: +margin/+ECC, group 4: -margin/+ECC). The rate of histologically proven recurrent CIN was calculated for each group and compared using chi(2) analysis. The effect of +margins, +ECC, degree of dysplasia, and CD4 count on the risk of recurrence was determined by logistic regression. RESULTS: Forty-nine percent of patients with negative margins and negative ECC experienced recurrence, most within 36 months. There was no significant difference in recurrence rate for patients with positive margins (69.2%, P = 0.19), positive ECC (50%, P = 0.97), or positive margins and ECC (66.7%, P = 0.41) when compared to patients with complete excision of dysplasia. No significant difference in the mean CD4 count of patients with and without recurrent dysplasia (316 vs. 390 cells/mm3, P = 0.37) was observed. Logistic regression showed only degree of dysplasia in the cone specimen to have a marginally significant linear relationship with recurrence. CONCLUSION: Cervical conization is not an effective method for eradicating CIN in HIV-positive women. Most patients will recur despite complete excision of dysplasia. Surgical margin status, ECC status, and CD4 count appear to have no effect on recurrence rate. Although multiple procedures were necessary in some patients, cone biopsy was effective in preventing progression to invasive cervical cancer in all cases.

Adult↗

PubMed2000

Predictive factors for residual disease in subsequent hysterectomy following conization for CIN III.

OBJECTIVE: The aim of this study was to determine predictive factors for post-cone residual disease in subsequent hysterectomy for CIN III. METHODS: From June 1994 to June 1999, 120 patients with CIN III who received hysterectomy within 6 months of conization regardless of marginal status were identified from 1450 conization cases. The demographic features and pathologic parameters were analyzed for the predictive rate of post-cone residual disease. RESULTS: Age >==50 years and parity >==5 were significant factors associated with residual disease. The incidence of residual disease was 56.5 and 29. 3% in patients >==50 and <50 years, respectively, and 61.8 and 36.0% in patients with parity >==5 and <5. Post-cone endocervical curettage (ECC) and multiple-quadrant disease were the only pathologic predictive factors identified. The incidence of residual disease was 64.6 and 29.2% in patients with positive ECC and negative ECC, respectively, and 48.4 and 25.9% in patient with multiple-quadrant disease and one- or two-quadrant disease. Other pathologic parameters, including endocervical margins, ectocervical margins, endocervical gland involvement, and depth of conization, were not predictive of residual disease. When ECC was combined individually with age, endocervical margins, or multiple-quadrant disease, there was no increase of positive predictive rate. CONCLUSIONS: (1) Age 50 years or more and parity >==5 were two demographic features that predicted post-cone residual disease. (2) ECC and multiple-quadrant disease were the only pathologic parameters that predicted post-cone residual disease. (3) With the appropriate application of the predictive factors, post-cone hysterectomy may be further decreased.

Adult↗

PubMed2002

Disease persistence in patients with cervical intraepithelial neoplasia undergoing electrosurgical conization.

OBJECTIVE: Cone margin status has been reported to be the most important predictor of residual disease in patients with cervical intraepithelial neoplasia (CIN) undergoing electrosurgical excisional treatment. The primary aim of this study of patients treated with electrosurgical conization was to evaluate the association of cone margin status and other clinical and pathologic factors with the probability of residual disease. METHODS: The study population comprised 699 patients with at least one follow-up visit within 12 months of conization. Residual disease was defined as a histology diagnosis of CIN within 3 years of conization. Multivariate associations were evaluated with multiple logistic regression analysis. RESULTS: Attendance to follow-up was 97% for the second visit and 34% for the third visit. Residual disease was detected in a total of 38 patients (5.4%). The detection rate was 3.3% at the first visit, 2.1% at the second visit, and 0.4% at the third visit. An increased probability of residual disease was associated with a referral Pap smear reported as high-grade squamous intraepithelial neoplasia and carcinoma (odds ratio, 2.9; reference category, low-grade squamous intraepithelial neoplasia). A decreased probability was associated with a squamocolumnar junction entirely visible at the first follow-up visit (odds ratio, 0.2; reference category, squamocolumnar junction not visible). Patient age, time period, lesion size, lesion site, grade of CIN, cone width, cone depth, and margin status had no influence. CONCLUSIONS: The determinants of residual disease in this study differed from those generally reported so far. Factors associated with effectiveness of electrosurgical treatment of CIN need further research.

Adult↗

PubMed1996

Conization for cervical intraepithelial neoplasia is followed by disappearance of human papillomavirus deoxyribonucleic acid and a decline in serum and cervical mucus antibodies against human papillomavirus antigens.

OBJECTIVE: Our purpose was to investigate whether conization for cervical intraepithelial neoplasia eliminates human papillomavirus deoxyribonucleic acid and effects the levels of serum and cervical mucus antibodies against human papillomavirus antigens. STUDY DESIGN: Analysis of paired cervical brush and serum samples taken from 23 women with cervical intraepithelial neoplasia before and 16 to 27 months after conization was performed for presence of human papillomavirus deoxyribonucleic acid by polymerase chain reaction and for human papillomavirus antibodies by enzyme-linked immunosorbent assay. RESULTS: Four women had recurrent cervical intraepithelial neoplasia, whereas 19 women were disease free. Eighteen of 23 women were positive for human papillomavirus deoxyribonucleic acid before treatment. At follow-up only the 4 women with recurrent cervical intraepithelial neoplasia were positive. Serum immunoglobulin G levels and A levels and immunoglobulin A levels in cervical mucus against most of the tested human papillomavirus antigens had declined at follow-up. CONCLUSIONS: Human papillomavirus deoxyribonucleic acid was regularly eliminated and human papillomavirus antibody levels, especially local immunoglobulin A, declined after efficient treatment, suggesting that conization may be effective for treating the underlying human papillomavirus infection.

Adult↗

PubMed1997

Conservative conization for microinvasive carcinoma of the cervix.

OBJECTIVE: Our purpose was to examine conservative conization as treatment for microinvasive carcinoma of the cervix with depth of invasion < 3 mm. STUDY DESIGN: Twelve patients with microinvasive carcinoma of the cervix underwent cervical conization under colposcopic guidance followed by careful observation. RESULTS: The 12 patients were alive without evidence of disease after a mean follow-up of 6.7 years. Four pregnancies with term deliveries were identified. CONCLUSION: Microinvasive carcinoma with a depth of invasion < 3 mm without confluent invasion or lymph vascular involvement can be treated successfully with conservative conization and provided a good pregnancy outcome.

Adult↗

PubMed1997

Duration of pregnancy after carbon dioxide laser conization of the cervix: influence of cone height.

OBJECTIVE: To determine if carbon dioxide laser conization of the cervix is a risk factor for preterm delivery in subsequent gestations and to evaluate whether there is any relationship between cone height and duration of pregnancy. METHODS: Patients of fertile age who had carbon dioxide laser conization were followed for reproductive events. Cases were matched one-to-one with controls for known risk factors for preterm delivery. Pregnancy duration, rate of preterm birth, and mode of delivery were studied. Parametric and nonparametric tests were used for statistical analysis. Logistic regression analysis and Cox proportional hazard modeling were used to investigate the relationship between cone height and subsequent preterm delivery. RESULTS: Sixty-four women with singleton pregnancies after carbon dioxide laser conization and 64 controls were included in the study. Overall, no difference was found in the rate of preterm delivery and duration of pregnancy. However, women with cone height of at least 10 mm had a higher rate of preterm delivery than either those with cone height less than 10 mm (five of 23 versus one of 41, P = .01) or the controls (five of 23 versus three of 64, P < .05). Cone height of at least 10 mm remained significant in predicting the occurrence of preterm delivery and the duration of pregnancy after adjusting for known risk factors (odds ratio 11.1, P < .05). CONCLUSION: Cone height of at least 10 mm is an independent risk factor for the duration of pregnancy and for the occurrence of preterm delivery in the subsequent gestation.

Adult↗

PubMed2003

Frozen section examination of the endocervical margin of cervical conization specimens.

OBJECTIVE: We conducted this retrospective study to determine accuracy of frozen section examination of endocervical margin during cold knife conization. METHODS: Between June 1993 and June 2001, 310 consecutive patients underwent cervical conization for squamous intraepithelial lesion or stage IA1 cervical cancer. Before 1997, the surgical specimens of 149 patients were processed following a standard pathological procedure (historical group). After 1997, a frozen section of the upper endocervical margin was processed during surgery for 161 patients. If the upper endocervical margin was involved with intraepithelial neoplasia, the surgeon performed a second resection if possible. Results of the frozen section examination were compared with the final diagnoses to determine sensitivity, specificity, and positive and negative predictive values. The usefulness of this procedure was evaluated by comparison of positive margin status rate with the one of the historical control group. RESULTS: For the diagnosis of intraepithelial neoplasia involving the endocervical margin, the sensitivity, specificity, and positive and negative predictive values of frozen section were 91%, 100%, 100%, and 98%, respectively. Eleven patients had definitive positive endocervical margin in the frozen section group (three false negatives, six patients without additional resection, and two patients with intraepithelial neoplasia involving the upper margin of the additional resection) and 17 patients in the historical group (P =.16). CONCLUSION: Frozen section examination of the endocervical margin of cervical specimen obtained during cold knife conization is highly accurate. Its clinical relevance has to be demonstrated in a multicenter study.

Adult↗

PubMed1995

A randomized study comparing suture with non-suture cold-knife conization.

OBJECTIVE: To compare the short-term outcome of cold-knife conization between suture and non-suture (with Monsel's solution pack) methods. METHODS: Between February, 1990 and March, 1992, 142 patients underwent cold-knife conization were randomly allocated into 2 groups. The hemostasis was done by suture in one group and by Monsel's solution pack without suture in the other group. The patients' and cone specimens' characteristics as well as short-term outcome were recorded and compared using Chi-square test, Fisher exact test and t-test where appropriate. RESULTS: The patients' characteristics, cone size, and histologic diagnosis of both groups were comparable. The non-suture group had shorter operative time (10.69 +/- 7.86 vs. 20.04 +/- 6.99 minutes) and lesser late hemorrhage (2.9 vs. 15.9%) than the suture group (p < 0.05). There was no statistical difference in the operative blood loss. CONCLUSION: The non-suture method of conization should replace the traditional suture method.

Adult↗

PubMed2002

Utility of bipolar electrocautery scissors for cervical conization.

OBJECTIVE: To evaluate the usefulness of bipolar electrocautery scissors for cervical conization. METHODS AND MATERIALS: Forty patients with severe dysplasia/in situ carcinoma of the uterine cervix underwent cervical conization: 20 randomly selected patients were operated on with the unipolar energy scalpel and the other 20 were operated on with bipolar electrocautery scissors. In both groups operating time, number of ligations, blood loss, duration of recovery, perioperative complications and adequacy of the margins of the lesion were assessed. Data were compared by analysis of variance. RESULTS: In the bipolar group the average operating time and duration of recovery were significantly reduced (halved), no ligations were needed and the amount of blood loss was significantly reduced. Regarding perioperative complications, in the bipolar group there were no hemorrhages nor need of a second operation or transfusion. Infections did not occur in either group. We found no difference between the two groups regarding adequacy of the margins of the lesion for a good pathologic examination. CONCLUSION: Bipolar electrocautery scissors were safe and useful in cervical conization by reducing the operating time and blood loss without increasing postoperative morbidity.

Adult↗

PubMed2002

Outcome of pregnancies after cold-knife conization of the uterine cervix during pregnancy.

OBJECTIVE: To determine the incidence of cervical intraepithelial neoplasia (CIN) in pregnancy and to determine the outcome of pregnancies in women treated by cold knife conization during pregnancy. METHODS: The authors retrospectively studied the cases of 19,807 pregnant patients, who presented to the 1st Department of Obstetrics and Gynecology Semmelweis University Faculty of Medicine between January 1, 1993 and December 31, 1997. Of these, there were 1,513 spontaneous abortions, 6,170 artificial abortions and 12,124 deliveries. Cytological evidence of a high-grade squamous intraepithelial lesion (LGSIL) was found in 48 pregnant patients. A low-grade squamous intraepithelial lesion (LGSIL) was found in 55 pregnant patients. All pregnant patients with HGSIL including those with satisfactory and nonsatisfactory colposcopical examinations underwent diagnostic cold knife conization during pregnancy in the second trimester. A gynecologic pathologist (Dr. Zs. Csapó) reviewed the histopathological sections. RESULTS: Overall, 44 patients had CIN, three patients had microinvasive carcinoma (FIGO stage I/A1), and one patient had neither CIN nor invasive carcinoma in the HGSIL group. Among the 48 pregnant patients with HGSIL, there were two spontaneous abortions occurring during the 21st and the 22nd gestational weeks respectively, so the pregnancy loss rate was 4.2%. Forty patients (83%) delivered at term and six patients (12.5%) at preterm. Twenty-four patients (52%) delivered vaginally and 22 (48%) by cesarean section. Comparing this data with the control group consisting of pregnant patients who had LGSIL, the difference between the two group as regards the total number of adverse pregnancy outcome cases was not significant. In the three patients with microinvasive cervical carcinoma (FIGO stage I/A1), elctive cesarean section was performed, followed by an immediate abdominal hysterectomy at term. CONCLUSION: The incidence of CIN in pregnancy was 0.22%. The incidence of microinvasive cervical carcinoma was 0.015%. Pregnant patients with CIN who underwent cold knife conization during pregnancy were not at increased risk of adverse pregnancy outcome, however they were at increased risk of cesarean delivery.

Abortion, Induced↗

PubMed2002

[Laser conization for cervical intraepithelial neoplasias, grade III. Personal experience of 77 cases].

BACKGROUND: Evalutation of the efficacy of laser conization for cervical high-grade squamous intraepithelial lesions (Hg-SIL). METHODS: A retrospective evaluation. Case collection: A total of 77 women, 47 outpatients and 30 inpatients with endocervical CIN3 or CIN2, were treated by carbon dioxide (CO2) laser between 1993 and 1995. A preoperative diagnosis has been made by means of Pap-smear, colposcopy and marked biopsy. In 47 cases a laser conization was performed in Day Surgery, without vessel constrictors or local anesthetics. In 30 cases a narcosis (Diprivan ) was induced. The former were discharged 2-3 hours and the latter 24 hours after treatment. RESULTS: The histological examination confirmed preoperative diagnosis in 64 (86.5%) cases and negligible one grade discrepancy was reported in 7 cases (6 over- and 1 underestimated); missed invasion and no free margins were reported in the remaining 4 and 2 patients respectively, so these latter 6 patients were submitted to other surgical procedures. No serious complications occurred with the exception of mild vaginal postoperative bleeding. During the follow-up of 36-82 months, cervical alterations were described only in 12 out of 71 cases, flat condilomatosy in 8 cases, CIN2 in 2 patients and CIN3 in other 2 patients. At present, all the patients are free of disease. CONCLUSIONS: The conization with dioxide laser is a good therapy for cervical intraepithelial neoplasia, even if expensive; infact poor side-effects are observed as well as a very good reliability.

Adult↗

PubMed2003

Delayed, massive bleeding as an unusual complication of laser conization. A case report.

BACKGROUND: Although delayed bleeding following cervical conization is a common complication of this surgical procedure, the amount of blood loss is usually not life threatening. CASE: A 27-year-old woman underwent conization with a KTP laser for the treatment of microinvasive cervical adenocarcinoma. Eight days later the patient experienced sudden, massive genital bleeding at her workplace. The source of the bleeding was identified as a descending branch of the left uterine artery exposed to the wound surface. Hemostasis was achieved completely with direct surgical ligature of the exposed blood vessel. The patient's blood loss during the course of the events was estimated to be 3.2 L, for which she received 1.4 L of packed red blood cells. She had an uneventful postoperative recovery. There was no bleeding or recurrence of the disease during 4 years of follow-up. CONCLUSION: Clinicians should be alert to the possibility of massive bleeding as a delayed surgical complication of cervical conization.

Adenocarcinoma↗

PubMed1997

Diagnostic and therapeutic technique of cervical conization with "cold knife" using fibrin glue. Preliminary outcomes.

In recent years many Authors have proposed several techniques and surgical tools to perform conical or cylindrical excisions of the portio and cervical canal. For instance, we can perform conization using a traditional "cold knife" (scalpel), CO2 laser with focal bundle, radiothermic or fine needle electroconization (Loop Electrosurgical Excision Procedure-LEEP-; Large Loop Excision of Transition Zone-LLETZ-). Our goal has been to change traditional conization of the cervix with "cold knife" using Hegar dilatators to delineate the cone we have to remove and prevent lesions in the cervical canal; furthermore, using fibrin glue (Tissucol-R) to do a considerable haemostasis. The performance takes about five minutes under local anaesthesia and it has been possible to study the patients with a 24-month follow up. The results the Authors obtained have been low blood loss, diagnostic and histological accuracy, better colposcopic follow-up, any angle-shots or abnormality of the cervical canal and any physical-chemical modifications of the ovulatory cervical mucus. The advantages of traditional conization we modified are still valid; however, others procedures have a clinical and therapeutical significance but concerning histological and diagnostic investigations they could give a negative result.

Cervix Uteri↗

PubMed1997

Prophylactic cerclage in pregnancy. Effect in women with a history of conization.

OBJECTIVE: To evaluate the effect of prophylactic cerclage on the course of pregnancy in women with prior conization. STUDY DESIGN: In a retrospective, observational study, the outcome of pregnancies in 69 women with (n = 30) and without (n = 39) cerclage who previously underwent conization was evaluated regarding hospitalization due to threatened preterm labor and delivery before 37 weeks of gestation. RESULTS: The occurrence of preterm delivery was 23.3% in the cerclage group and 20.5% in the control group (P = .78). Women with prophylactic cerclage were hospitalized significantly more often due to threatened premature labor: with cerclage, 66.7%; without cerclage, 33.3% (P = .006). CONCLUSION: Prophylactic cerclage should be used more sparingly in women with a history of conization because it does not prevent premature delivery and tends to induce preterm uterine contractions.

Adult↗

PubMed1997

A new surgical instrument for diathermic conization of the uterine cervix.

A surgical instrument for uterocervical diathermic conization has been constructed for adequate treatment of patients with mild to severe dysplasia (CIN I-III) of the uterine cervix. The purpose of the instrument is to provide a simple means of performing a differentiated conization tailored to the anatomy of the patient and the extent of the disease. With this instrument conization of the uterine cervix may be performed on an out-patient basis. It includes a mount holder member for a diathermic wire that fits into a pistol grip. The wire is held in tension by the mount so that the wire forms an angle alpha to the longitudinal axis of the mount. The wire then cuts out a cone when the mount is turned through a complete revolution. Angle alpha of the wire may be adjusted on the mount thus enabling variation in the size and shape of the cone that is excised.

Cervix Uteri↗

PubMedDate not supplied

[Condylomatous lesions of the uterine cervix: LLETZ conization].

Eight cases are reported about women with the diagnosis of HPV related lesions; a "dot-blot" hybridization technique with radioactive probes was done with each of them, also a conization with a diathermic loop (LLETZ) and a post operative follow-up with methods such as Pap smear, colposcopy and hybridization. We think the way we manage HPV related lesions has the advantage of an accurate diagnosis, with the exact envolved HPV type, and it discards the possibility of an infiltrating carcinoma, after studying the conization sample. Hybridization techniques are complementary to Pap smear in order to know the infective viral type and to exclude a possible occult infection in the post-operative period. LLETZ conization ended up as a quick and easy technique with no postoperative problems and with a proved efficiency, since neither recurrences were found (with citology) nor viral DNA was detected, the technique is not too complicated and takes about 30 minutes.

Condylomata Acuminata↗