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PubMed1993

Cervical conization and preterm delivery/low birth weight. A systematic review of the literature.

OBJECTIVE: Evaluate the effect of cervical conization on preterm birth/low birth weight (LBW). DESIGN: A systematic review of the literature using external or internal controls. RESULTS: The typical odds ratio for preterm delivery in women with prior cervical conization using external controls was 3.23 (95% confidence interval 2.29-4.55). Using internal controls the typical odds ratio for LBW was 2.97 (95% confidence interval 1.09-8.05). Using external controls the typical odds ratio for LBW was 2.31 (95% confidence interval 1.33-3.99). CONCLUSION: Women with cervical conization are at higher risk for preterm birth than external controls, and the surgical intervention as such is a major determining factor.

Cervix Uteri↗
PubMed2001

Outcomes of carbon dioxide laser conization for the treatment of cervical intraepithelial neoplasia grade III.

PURPOSE: The aim of this study was to determine the rates of incomplete excision of cervical intraepithelial neoplasia (CIN) III after carbon dioxide laser conization, and the risk of reappearance of CIN depending on the excision margins. METHODS: A total of 153 women who underwent carbon dioxide laser conization for CIN III between 1988 and 1998 at our hospitals were eligible for inclusion in the study and their notes were retrospectively studied. RESULTS: Histological examination of the excision margins revealed complete excision in 134 (87.6%), uncertain margins in one, and extension of CIN to the margins in 18 (11.8%) cases. The treatment failure rate in the cases with clear margins was 2.2% (3 of 134), and in the cases with involved margins 44.4% (8 of 18) (p < .001). CONCLUSION: Carbon dioxide laser conization despite the worldwide use of LLETZ still has a place in the treatment of CIN. Very high rates of complete excision were achieved. As incomplete excision does not always result in treatment failure, neither do clear margins always indicate eradication of the disease.

Adult↗
PubMed1992

[Acceptance of ambulatory laser conization under local anesthesia by Danish women].

The aim of the study was to evaluate the acceptability of CO2 laser excisional conization for cervical intraepithelial neoplasia under local anaesthesia in an outpatient setting. Seventy-seven patients, who underwent this procedure, were interviewed three months later concerning pain during treatment, pain and bleeding in the immediate postoperative period, and their general opinion about this procedure. The median duration of surgery was 11 minutes. The postoperative median observation time was 90 minutes. Seventy-one women experienced no discomfort during treatment. Thirty-one patients needed mild analgesics for an average of three days. Bleeding continued for a mean of 7.7 days after treatment and 73% experienced the bleeding as less, 8% as more as compared to menstrual bleeding. Ninety-two percent of the women would prefer this procedure if they had to undergo conization once again. In conclusion, we found a high acceptability in women treated with CO2 laser excisional conization under local anaesthesia in an outpatient setting.

Adult↗
PubMed1992

Effect of CO2 laser conization of the uterine cervix on pathologic interpretation of cervical intraepithelial neoplasia.

The CO2 laser has become a valuable tool for the treatment of lower genital tract neoplasia. The records of 52 women who underwent CO2 laser cervical conization were analyzed retrospectively to evaluate the effect of tissue thermal damage on histopathologic interpretation. Lesion evaluability, defined by the ability to diagnose neoplasia accurately in the specimen, was satisfactory in only 26 cases; in the other 26, thermal damage was severe enough to preclude accurate diagnosis. A postoperative diagnosis of cervical intraepithelial neoplasia III was made in 17 instances, and microinvasion was suspected but unverifiable in two of these. Two patients had frankly invasive cancer, but vascular space involvement in one could not be evaluated accurately because of thermal damage. Tissue thermal damage sufficient to interfere with accurate histologic evaluation was noted in the majority of laser conization specimens. The value of a conization is both diagnostic and therapeutic. The potential impact of a diagnosis compromised by thermal damage is serious.

Adolescent↗
PubMedDate not supplied

[Fertility and pregnancy after conization].

Conization is frequently used as a diagnostic and curative method for the prevention of the cervical cancer on women of the fertile age. Conization was performed on 408 women up to 40 years in our Clinics during the years 1967 to 1989. The percentage of attested postoperative pregnancies among these women amounts to 13.51% and declines with age; it is high among women up to 25 years of age (29%) and low (3%) among women between 36 and 40 years. The percentage with premature births before the operation was 15.25%; after the operation the percentage declined to 13.31%. Preventive cerclage was used on one part (8.1%) of the latter percentage and no cerclage on the remaining 5.4%. It is concluded that there is not high danger of premature birth after conization and therefore performance of the operation does not seem to necessitate preventive cerclage.

Abortion, Spontaneous↗
PubMed1990

Cervical conization findings in women with dysplastic cervical cytology and normal colposcopy.

A review of 134 cervical conizations performed in a 36-month period showed that 18 were performed on patients with two or more cervical smears showing dysplasia but with essentially negative, satisfactory colposcopic evaluations, including normal colposcopically directed biopsies and endocervical curettings. A histologic diagnosis of cervical intraepithelial neoplasia (CIN) of various grades was established in 15 (83%) of the 18 conization specimens. Six (33%) of the 18 specimens harbored CIN 3. The histologic diagnosis of a more severe lesion than that indicated on cytology was rendered in five of the cases. Cervical conization should be performed when colposcopic evaluation of the cervix, vagina and vulva fails to identify the source of persistent CIN on Papanicolaou smears.

Adult↗
PubMed1985

[Analysis of 194 conizations: residual lesions require hysterectomy].

CIN I and CIN II can be treated by colposcopy-guided biopsy. Control examinations must be made every six months. Persistence of a CIN II lesion is an indication for conization. Some CIN III cases can be treated by conization, but considering the frequency of residual lesions and insufficient conization, a total hysterectomy is a safer procedure.

Adult↗
PubMed1978

Comparison of cold conization and directed biopsy.

A study was performed to compare the results of directed biopsy with those of cold conization of the cervix in the private practice community. The intent of the study was to determine whether the two procedures were comparable in accuracy, to compare them in terms of economic impact and to compare the complications of each procedure. The study shows that directed biopsy is as accurate as cold conization of the cervix, is less expensive for the patient and is not fraught with as many serious hazards as is cold conization.

Biopsy↗
PubMed1984

[Preoperative diagnosis for stage II endometrial carcinoma using endocervical conization].

It is generally difficult to identify stage II endometrial carcinoma correctly. To differentiate cervical involvement, endocervical conization was performed on 31 patients with endometrial cancer between May 1982 and September 1983. The preoperative diagnosis of stage II endometrial carcinoma was confirmed by postoperative histologic examination. In stage I patients, there was no microscopic cervical involvement after the operation. Fractional curettage and hysteroscopy are commonly used to detect stage II endometrial carcinoma. However, these examinations may overlook cervical stromal invasion. Endocervical conization is a simple procedure and highly useful to detect cervical stromal involvement. We recommend the of endocervical conization combined with hysteroscopy to diagnose stage II endometrial carcinoma.

Adenocarcinoma↗
PubMed1983

Cure rates after laser conization for early cervical neoplasia.

Follow-up results by vaginal cytology and colposcopy after laser conization for early cervical neoplasia in 333 patients are reported. 95.7% of all the women were free from disease after 4-24 months. The separate figure for very early invasive carcinoma was 96.4% and for CIN III through CIN I it was 96.6%, 94.9% and 90.6% respectively. The cure rate depended on whether or not the resection margins of the cones were free from epithelial cells with atypia. The highest cure rate, 97.8%, was noted for CIN III with margins free from atypical cells. Out of patients not free from disease, 92.9% were detected at the first follow-up at 4--6 months after conization and represent persistent disease. Laser conization seems to give at least as good cure rates as laser vaporization and has the chief advantage that histopathological evaluation is available both for the whole lesion and the resection of the cones. The procedure can be safely performed on an out-patient basis.

Adult↗
PubMed1983

Colposcopically directed conization for frozen-section examination in the management of cervical intraepithelial neoplasia.

We found colposcopically directed conization for frozen-section (F/S) examination to be 100% accurate in ruling out the presence of invasive cervical carcinoma. Therefore, the definitive treatment for cervical intraepithelial neoplasia (CIN)--hysterectomy in women who do not want more children--could be performed while the patient was still under the anesthetic used during procurement of the conization specimen. This technique reduces the risk of using anesthesia a second time and also reduces the costs of CIN treatment. Colposcopically directed conization should be done by experienced colposcopists only.

Adult↗
PubMed1983

The colposcopy clinic in a residency training program. Five years' experience with colposcopically directed biopsies followed by conization or hysterectomy.

Five hundred fifty-four patients with abnormal cytologic smears were screened in a special clinic by gynecology residents under faculty supervision using colposcopy and biopsies. Two hundred fifty patients who were evaluated by colposcopy subsequently had conization or hysterectomy. Colposcopically directed biopsies were accurate (comparable to the surgical specimen) in 92%. Three patients had invasive cancer high in the endocervical canal that was found by conization after endocervical curettage and colposcopy had indicated less-severe disease. Persistent or recurrent dysplasia was found in approximately 5% after conization and in none after hysterectomy. Because 23% of patients were lost to follow-up after treatment and an additional 19% had inadequate follow-up, management of CIN III with local destruction (cryocautery, electrocautery, laser) does not seem advisable.

Adolescent↗
PubMed1994

[Electro-conization of the uterine cervix in the Department of Oncologic Gynecology in Lodz in the years 1968-1987].

Considering the carcinoma incidence rate in women population the cervical carcinoma takes the second place. The diagnosis and proper treatment of the precancerous conditions and the preinvasive carcinoma cause the reduction of invasive cancer incidence rate. In this paper, it has been presented 20-years experience concerning cervical electro-conization in above mentioned department. The 1515 patients with the precancerous conditions and the carcinoma intraepitheliale were studied. The electro-conization has made possible the recovery in 98.0% patients. It has been found that the electro-conization is a very valuable diagnostic and therapeutic procedure, does'nt cause any serious complications and provide with undamaged samples for histopathological studies.

Adolescent↗
PubMed1994

Loop electrosurgical excision procedure for conization of the uterine cervix.

The application of loop electrosurgical excision procedure (LEEP), a new method of conization of the uterine cervix used to diagnose cervical intraepithelial neoplasia (CIN) or cervical cancer is presented herein. A loop electrode consists of a thin wire that allows deep excision of the transformation zone (TZ). The cone-shaped tissue removed can be examined histologically. Over a period of one year, a total of 41 cases underwent LEEP. Without anesthesia, the patients did not have any noticeable pain during the procedure. There were no complications, such as fever, wound infection, massive bleeding or cervical stenosis. In low-grade CIN, follow-up colposcopy and cytology did not show persistence or recurrence. In two cases of high-grade CIN, subsequent hysterectomy revealed residual lesions on hysterectomized specimens. LEEP is a simple and quick procedure of diagnostic conization that can be done at the first visit without major complication. If the histopathology after LEEP is moderate- to high-grade CIN or invasive cancer, the conization cannot be regarded as a sufficient therapeutic procedure, and such a patient needs further treatment.

Biopsy↗
PubMed1994

[Electro-conization with the diathermic loop. Indications and results].

The experiment of electro-conization with diathermic loop was effected on 185 patients. The indications are represented by: a) low grade lesions: 21 cases (11.3%) only when the squamo-columnar junction was into the endocervix; b) CIN 2: 44 cases (23.7%): c) CIN 3: 118 cases (63.7%); d) cyto-histologic discordance: 2 cases. After one year, the following results could be noted: 94.1% of the patients were cured, only 11 out of the 185 presented a recurrence (or persistence). It seemed interesting to us to study the factors which could influence the "in sano" (Free margin)/or not character of the resection. It appeared that the surface of the lesion did not seem to influence its histological result since we got: 83%, 96%, 94.5% and 92.3% of "in sano" conizations to be correlated with a lesion surface equal to 1/4, 2/4, 3/4, 4/4 of the cervical area. The second factor to be studied was the patients' age. So from 15 to 25 years (96%) of the resections were "in sano". There from 26 to 35 (92%), and from 36 to 45 (91.9%). Among post-menopausal women from 46 to 55 years old only 86.4% of electro-conizations were "in sano". Histologic alterations of the histologic specimen were noted in two cases (1%), the interpretation was easy and clear in the other cases. What about the complications? In 2 cases a moderate stenosis was to be noted; in 2 other cases: post-operative hemorragiae which were treated by a selective electro-coagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

Cervical cytology after cryosurgery, laser ablation and conization. A comparison of the cotton swab and endocervical brush.

Obtaining an adequate Papanicolaou smear, as evidenced by the presence of endocervical cells, is paramount in following patients after treatment for cervical dysplasia. A randomized, prospective trial was done in which 203 patients with a history of cryosurgery, laser ablation or cone biopsy were randomized into two groups: 114 patients had cervical smears done with a cotton swab and 89 patients with an endocervical brush. The presence or absence of endocervical cells was noted on the cytology report. Overall, the endocervical brush produced significantly more adequate smears than did the cotton swab (86% vs. 74%, P = .0389). Within each subgroup the endocervical brush consistently produced a higher number of adequate smears than did the cotton swab: after cryosurgery, 86% vs. 82%, P = .7242; after laser ablation, 95% vs. 88%, P = .61; after conization, 76% vs. 47%, P = .0675. The difference was most notable in the conization group. The endocervical brush is superior to the cotton swab in obtaining satisfactory Papanicolaou smears after cryosurgery, laser ablation and conization.

Adult↗
PubMed1998

CO2 laser conization for cervical intraepithelial neoplasia grade II-III: complications and efficacy.

AIMS: To examine per- and postoperative complication rates and efficacy of laser conization in the treatment of cervical intraepithelial neoplasia (CIN) grade II-III. MATERIAL AND METHODS: Eligible for analyses were all women treated with their first laser conization because of CIN II-III during the time-period January 1, 1983 to December 31, 1992. The study population comprises 1081 women who were permanent residents of one Norwegian county (Sør-Trøndelag). All analyses were performed in SPSS applying chi-square for trend, Mann-Whitney test, survival analyses and logistic regression. RESULTS: In total 86 women (8.0%) were observed with one or two (4:86) complications. Bleeding was most frequent (n = 66) followed by symptomatic cervical stenosis (n = 18). Most bleeding complications (74.2%) occurred one to two weeks postoperatively. Both bleeding complications and the occurrence of cervical stenosis were associated with cone height. Three emergency hysterectomies, two for bleeding and one for bladder perforation, were performed. Persistent disease was diagnosed in 1.9% (20:1053) of the women. All women with persistent disease were diagnosed among those with CIN III. Persistent disease was more than 20 times more common among women with disease-involved resection margins compared to those with free resection margins. CONCLUSIONS: Our evaluation of ten years' consistent use of conization by CO2 laser in the treatment of CIN II-III in an unselected population showed a low overall complication rate (8%) and very high efficacy (CIN II 100%, CIN III 98.1%) of the treatment.

Adult↗
PubMed1999

Randomized study comparing two techniques of conization: cold knife versus loop excision.

OBJECTIVE: To compare the histomorphologic and colposcopic results of cold knife conization and loop excision. METHODS: Sixty-six women were randomly allocated to have the cone specimen removed by cold knife excision (n = 38) or loop excision (n = 28). Subjects eligible for inclusion were those who presented histologically verified grade 3 cervical intraepithelial neoplasia (CIN) or grade 2 CIN with squamocolumnar junction not seen. RESULTS: The mean height of the cone specimens was greater in the cold knife group [18.9 mm (SD = 5. 5) and 12.8 mm (SD = 4.3), respectively; P = 0.0001], as was the frequency of clear margins (100 and 80%, respectively; P = 0.001). In the loop excision group, thermal injuries were present in half of the cone sections. The median (range) thickness of thermal injury was 0.98 mm (0-1.5 mm) in the ectocervix and 0.95 mm (0-1.75 mm) in the endocervix. Histologic evaluation of the endocervical margins was not possible in 2 cases (7%). At follow-up colposcopy, evaluation of the entire squamocolumnar junction was possible in 15 (39%) and 20 (71%) women, respectively (P < 0.01). Four patients in the cold knife group and 6 in the loop group had histologically confirmed persistent dysplasia (P > 0.05), yielding success rates of 90 and 79%, respectively (P > 0.05). CONCLUSIONS: Loop excision provides a sample that is adequate for histologic evaluation in most cases, results in the same success rate as cold knife conization, and allows optimal colposcopic surveillance in significantly more cases than cold knife excision.

Adult↗