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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↗
PubMed1998

A randomized study of local or general anesthesia for laser conization of the cervix.

Laser Conization of the cervix was performed in both inpatient and outpatient settings with either local or general anesthesia. All of the patients included had abnormal cervical smears, abnormal colposcopic findings and were allocated to one of two groups, A and B. Patients in group A had general anesthesia while patients in group B had only local anesthesia. A standard operative technique, was used and all patients had estimation of blood loss, recording of operative time, surgical suite time, anesthesia induction time, and assessment of postoperative pain and morbidity. Statistical analysis was performed using the student t-test. We concluded that laser conization of the cervix can be performed more cheaply with local anesthesia than with general anesthesia and with little discomfort, less nausea, and vomitting.

Adolescent↗
PubMed2005

A case of successful pregnancy after treatment of invasive cervical cancer with systemic chemotherapy and conization.

BACKGROUND: The standard therapy for invasive uterine cervical cancer causes loss of the woman's fertility. We report a successful pregnancy in a patient who desired fertility-sparing management of invasive cervical cancer and was treated with systemic chemotherapy and conization. CASE: A 28-year-old nulliparous woman was diagnosed with a large 30-mm-diameter stage IB1 squamous cell carcinoma of the uterine cervix. The patient received 4 courses of systemic chemotherapy with consecutive low-dose BOMP (cisplatin, bleomycin, vincristine and mitomycin C), which produced complete pathological response assessed by examination of specimens from conization. Two years later, the patient became pregnant, resulting in the birth of a healthy infant. CONCLUSION: This procedure is one method of conservative management to preserve fertility in invasive cervical cancer.

Adult↗
PubMed2006

Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3.

OBJECTIVE: To evaluate whether high-risk human papillomavirus (HR-HPV) detection and viral load prior to treatment and status of cone margins can predict residual/recurrent disease as well as the ability of current diagnostic tools to identify residual/recurrent disease during follow-up of high-grade cervical intraepithelial neoplasia (CIN) treated by conization using loop electrosurgical procedure (LEEP). METHODS: Two hundred and three women (mean age 38.6 +/- 9.7; range 22-83) with CIN2-3 treated by LEEP conization and confirmed in the surgical specimen, attending follow-up visits were included. Age, HR-HPV detection and viral load determined by HybridCapture 2, and cone margins were evaluated as possible predictors of residual/recurrent disease. Value of single and repeated cytology as well as HR-HPV detection and viral load during follow-up were analyzed as screening tools of recurrence. RESULTS: Residual/recurrent disease was demonstrated by colposcopy guided biopsy in 36 patients (17.7%). High HR-HPV load (>1000 RLU) prior to LEEP and positive cone margins were significantly associated with higher risk of recurrence (31.8% vs. 9.4%, P = 0.005; and 36.4% vs. 11.9%, P < 0.001 respectively). HR-HPV detection at 6-12 m after LEEP showed higher sensitivity than a single or repeated cytology (97.2% vs. 83.3% and 94.4% respectively) although it showed less specificity (81.4% vs. 92.2% and 82.6%). The combination of HR-HPV detection and the first cytology during follow-up detected all patients with residual/recurrent disease (sensitivity 100%, negative predictive value 100%) with an acceptable specificity (76.6%). CONCLUSION: The inclusion of HR-HPV testing with cytology in follow-up of patients treated for CIN2-3 would allow for fewer post-treatment visits and avoid unnecessary cytologies. High HR-HPV load prior to LEEP or positive margins should be considered as risk factors for developing residual/recurrent disease.

Adult↗
PubMed1998

Laser conization assisted by crypt visualization for cervical intraepithelial neoplasia.

OBJECTIVE: To describe intraoperative visualization of crypts and its effects on specimen clearance, safety, and clinical results of excisional treatment of cervical intraepithelial neoplasia (CIN). METHODS: We treated 147 patients with high-grade CIN (II-III) and colposcopically-assessed endocervical extension, using a CO2 laser instrument in a day-hospital setting. Endocervical walls were stained preoperatively with a 2% methylene blue aqueous solution. Cervical conization was done by laser under colposcopic vision. Stromal incision and cone shape were directed laterally to the endocervical crypts by intraoperative visualization in transparency of the stain. RESULTS: We were able to make stromal incisions at minimal and uniform radial distances from the cervical canal, thus allowing individualized cone shape and optimal bleeding control. Median (range) base diameter and height of specimens were 18 (13-24) and 20 (15-26) mm, respectively. The final histologic diagnosis was CIN II in 35 patients, CIN III in 111, and microinvasive carcinoma in one. Endocervical disease extension was confirmed in 103 patients (70%); the median (range) length of CIN in the 99 evaluable cases was 15.6 (0.5-25.7) mm, and crypt involvement was found in 39 (26.5%). All lateral margins were free of dysplasia. Four specimens (2.7%) had positive apical margins. No significant complications occurred, and fertility did not seem to be impaired. With a median (range) follow-up period of 68 (60-92) months, only 1.4% of patients experienced recurrence; two patients, both with involved crypts, had recurrent dysplasia at 23 and 45 months, respectively. CONCLUSION: Laser microsurgical conization assisted by crypt visualization facilitates safe and complete removal of CIN extending into the endocervix.

Adult↗
PubMed2001

Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone?

OBJECTIVE: To investigate whether high-risk HPV infection associated with cervical intraepithelial neoplasia (CIN) was successfully eliminated after electrosurgical conization by large-loop excision of the transformation zone (LLETZ). STUDY DESIGN: 142 women, who were admitted for conization of CIN 1-3 were recruited into a prospective follow-up study of HPV infection, including cervical sampling for HPV DNA before, and then 3, 6 and 12 months after surgery. We examined whether there were any differences in the rate of HPV DNA positivity after LLETZ between specific risk groups, such as patients with primary (i.e. before surgical treatment) high-risk HPV infection, CIN of different grades, and positive margins. RESULTS: We did not detect statistically significant differences between specific risk groups. According to the assay used (hybrid capture II) at the last follow-up visit 94% of primarily infected patients were completely free from infection with high-risk HPV types, while 6% had persisting HPV infection. CONCLUSIONS: With a detection limit of 5000 genomes/ml HPV DNA the hybrid capture II results revealed, that after electrosurgical removal of CIN in 94% of patients testing positive for high-risk HPV DNA prior to surgery were negative 12 months post-surgery.

Cervix Uteri↗
PubMed2006

[Late post-conization hemorrhage and false aneurysm of the uterine pedicle].

We report a case of delayed post-conization hemorrhage induced by the rupture of a uterine artery false aneurysm. Cold knife conization of the cervix was the main cause of the false aneurysm. To our knowledge, this is the first case reported. Angiography enabled the diagnosis and the treatment by embolization of the lesion. A less aggressive technique than a scalpel, perhaps with a diathermic loop, could help to prevent this type of complication.

Adult↗
PubMedDate not supplied

The value of loop electrosurgical conization in the treatment of stage IA1 microinvasive carcinoma of the uterine cervix.

The objective of this study is to assess the value of Loop Electrosurgical Conization (LEC) in the treatment of stage IA1 microinvasive squamous cell carcinoma (MIC) of the uterine cervix. Retrospectively, 82 patients with FIGO stage IA1 MIC, primarily treated with LEC on see and treat basis, were analyzed. After the initial LEC, 16 patients received cytologic and colposcopic follow-up only, 66 patients underwent a second procedure (repeat LEC, Cold Knife Conization (CKC), or hysterectomy), and four patients underwent a third procedure (hysterectomy). In 63 patients (77%) no residual CIN 3 or MIC was present after the initial LEC. Treatment of residual CIN 3 or MIC was equally effective with a repeat LEC as with CKC. One patient defaulted follow-up and developed a recurrence in the vaginal vault and was treated with a radical hysterectomy. LEC can be used as an alternative for CKC in treatment of patients with stage IA1 MIC. The advantage of LEC is that it can be performed as an outpatient procedure in addition to a diagnostic colposcopy and does not require a major anesthetic. Only a small number of patients will need a more extensive procedure.

Adult↗
PubMed2000

Regular disappearance of the human papillomavirus genome after conization of cervical dysplasia by carbon dioxide laser.

OBJECTIVE: We wished to evaluate the effectiveness of treatment of cervical dysplasia by laser conization in relation to persistence of human papillomavirus after treatment. STUDY DESIGN: Of 203 women referred to colposcopy because of an abnormal Papanicolaou smear, 149 women could be followed up for 3 years. A total of 108 women were treated by carbon dioxide laser excision, 4 women were treated by carbon dioxide laser evaporation, and 37 women were merely followed up. Cervical samples were taken before treatment and at follow-up 3 years later and were analyzed by nested general primer polymerase chain reaction for human papillomavirus deoxyribonucleic acid. RESULTS: Among women treated by laser conization, 82 (73.2%) had positive results for human papillomavirus deoxyribonucleic acid before treatment. Three women (2.7%) had a positive finding at follow-up, but no woman had the same human papillomavirus type on both occasions. Eighty-eight women had grade 1 to grade 3 cervical intraepithelial neoplasia before treatment, whereas during follow-up only 2 squamous cells atypias were found. CONCLUSION: The human papillomavirus genome present before treatment was regularly cleared, and there was also no recurrence of dysplasia. The results suggest that human papillomavirus testing is useful for monitoring the efficacy of treatment and that treatment modalities resulting in clearance of human papillomavirus should be favored.

Adult↗
PubMed2000

[Laser conization and laser ablation of the transformation zone].

OBJECTIVE: To evaluate postoperative courses and histological results after laser therapy of the transformation zone. METHOD: From 1993 to 1997, 136 laser interventions were performed (110 conizations and 26 vaporizations); 103 (76%) of these interventions were performed as outpatient procedures and 122 (89%) under local anesthesia. RESULTS: 94 (85%) of the 110 conizations showed tumor-free margins, whereas 12 (11%) had dysplastic changes in one or both margins. Follow-up of these 12 patients revealed 5 normal cytologic controls, 4 cases of hysterectomy without residual disease, 1 case of CIN III in the hysterectomy specimen, 1 case of CIN I in a radical hysterectomy (cervical cancer stage Ib in the histology of the conus), and 1 patient was lost to follow-up. In 4 cases (4%), there was only a suspicion of marginal involvement. These patients had either a normal cytologic control (n = 3) or no residual disease in the hysterectomy specimens (n = 1). There were eight bleedings that had to be treated with bicoagulation. CONCLUSIONS: Laser therapy offers the possibility of a very precise circumcision at the ectocervical site under colposcopic control. It can mostly be performed as an outpatient procedure under local anesthesia, and the frequency of postoperative complications compares to the other available methods. If the margins show dysplastic changes, follow-up rarely reveals recurrent disease. Expectative management with close cytologic follow-up is, therefore, justified in such cases, if fertility should be maintained.

Adult↗
PubMedDate not supplied

Atypical glandular cells of undetermined significance in cervical smears after conization. Cytologic features differentiating them from adenocarcinoma in situ.

OBJECTIVE: To evaluate the cytologic features of atypical glandular cells of undetermined significance (AGUS) smears following conization through a comparison with adenocarcinoma in situ (AIS) smears. STUDY DESIGN: Fifty cervical smears, diagnosed as AGUS based on groups of crowded glandular cells that raised the possibility of AIS, from 38 patients who had conization and 24 AIS smears, histologically confirmed, from 17 patients were reviewed. Subsequent follow-up biopsies or hysterectomies in 38 patients were evaluated. RESULTS: Nuclear atypia was a more reliable feature than architectural structure in differentiating postcone effect from AIS on cytology. The predominant cytologic features of the postcone smears were crowded glandular cells with a high nuclear/cytoplasmic ratio and relatively small, hyperchromatic nuclei with rather finely granular and uniformly dispersed chromatin, less distinct nuclear membranes, less frequent mitosis and presence of endometrial-type stromal cells in the background. The architecture of the crowded cells in the postcone smears was sometimes similar to that of AIS. No AIS or high grade squamous intraepithelial lesion histology was encountered in follow-up biopsies or hysterectomy specimens. CONCLUSION: The cytologic features distinguishing AGUS from AIS may be helpful in identifying the postcone effect. Since it is important to avoid miscalling the postcone effect as AIS, it is recommended that one check for a previous history of a cone biopsy.

Adenocarcinoma↗
PubMed1998

Hematometra and extended vaginal haematoma after laser conization. A case report.

A very rare case of haematometra and extended vaginal haematoma in a 53-year-old woman after laser conization is reported. The patient presented with amenorrhea and complete urinary retention. The possible pathogenesis of this complication is discussed. Ultrasonography, combined with physical examination were very helpful in determining the diagnosis. Cervical dilation and protection of surrounding tissues from thermal damage is recommended during laser conization to avoid similar complications.

Cervix Uteri↗
PubMedDate not supplied

[Conization with positive margins].

We received all conizations performed between 1986 and 1997. The incidence of positive margins conization for cervical intraepithelial neoplasia is 7.8% (23.8% in others studies). Persistent or recurrence disease occur only in 35% of cases; so new treatment is not always usefull and cytology and colposcopy are adequate for follow-up.

Adult↗
PubMed2000

Factors associated with cone margin involvement in CIN patients undergoing conization-equivalent electrosurgical procedure.

BACKGROUND: Most studies of cervical conization have considered the frequency of complications and the outcome of follow-up. The determinants of cone margin positivity have been inadequately described. In a series of CIN patients undergoing conization-equivalent electrosurgical procedure, we evaluated the factors associated with (i) any cone margin involvement, and (ii) endocervical margin involvement (with or without other locations) as contrasted with all other conditions. METHODS: Study population included 718 patients. Potential determinants of margin involvement were or were treated as categorical. Univariate analysis was based on the chi-square test. Multivariate associations were estimated by multiple logistic regression models. RESULTS: Cone margin involvement was observed in a total of 195 patients (27%). In univariate analysis, the frequency was positively related to histologic grade, time period, lesion size, and cone width and depth. In multivariate analysis, histology diagnosis and time period retained a strong association. The effect of lesion size was of borderline significance. The endocervical location emerged as a multivariate determinant of margin positivity. The effect of cone width and depth was not confirmed. Endocervical margin involvement was observed in 98 cases (14%). In univariate analysis, the frequency was positively associated with histologic grade, time period, and age, and inversely related to the visibility of the squamous-columnar junction. Multivariate analysis confirmed the strong effect of histology diagnosis and time period. The association with age and visibility of the squamous-columnar junction was weaker. CONCLUSIONS: Histology diagnosis and time period were the strongest determinants of cone margin involvement. Endocervical margin positivity was also related to patient age and visibility of the squamous-columnar junction. Cone width and depth had no protective effect.

Adolescent↗
PubMedDate not supplied

[Value of endocervical margin examination of conization specimens. Prospective study conducted on 150 patients].

OBJECTIVE: To assess the usefulness of frozen sections (FS) on endocervical margin in surgical conization or loop electrosurgical specimens. MATERIAL AND METHODS: In a prospective study, 150 patients were treated from October 1995 to December 1997: 69 cases without FS, 81 cases with FS. CIN on frozen section resulted in an immediate additional resection. RESULTS: In the group without FS, 13 patients had involved endocervical margin by high-grade CIN (18.8%). Frozen section was impossible in a conization specimen that was too short. FS revealed 64 normal glandular epitheliums, seven squamous metaplasias in which two lesions were under-evaluated (being in fact CIN on permanent sections), eight high-grade CIN followed by additional resection in six cases and two invasive carcinomas. Endocervical margin on additionals section were always free of disease. The rate of failure was 2.6% among 77 cases. This rate corresponded to two under-evaluations. Invasive carcinoma and CIN without additional resection were excluded because frozen section only allowed a peroperative diagnosis. The average height of the cone and the rate of complications were similar. Repeat surgery was necessary in nine cases in the group without frozen section, in which five showed residual lesions, absent in the other group. CONCLUSION: The ultimate histological interpretation was never difficult after frozen section. This method permits reduction of cases with involved cone margin and residual lesions and, despite some limitations, it may be useful for surgical management.

Adult↗
PubMedDate not supplied

[Utilization of CO2 lasers in continuous or pulsed mode for conizations: apropos of 230 cases].

OBJECTIVE: A retrospective study with the aim of analysing efficiency, anatomical and functional consequences of a conservative methodology for the treatment of cervical intra-epithelial neoplasias (CIN) using carbon dioxide laser. MATERIALS AND METHOD: Two hundred and thirty patients were treated and studied with an average waiting period of 38 months. During the study new methodology allowed a cut in the pulse regimen with adjustments in high energy levels. This allowed us to subdivide the study into two groups, respectively 113 and 117 patients, and to provide a differential rate of immediate and late complications. The pre-therapy lesion assessment led to a diagnosis of severe dysplasia (53%), carcinoma in situ (19.1%), mild dysplasia (20.4%) and investigational conization 7%; in one case, conization was provided for adenocarcinoma in situ. RESULTS: The anatomo-pathologic results showed 2.1% microinvasive tumors, 22.2% epidermoid carcinoma in situ, 2.1% adenocarcinoma in situ, 53.6% severe dysplasia, 14% mild dysplasia, 0.9% low dysplasia, and 5.2% viral lesions without dysplasia. The excision limit are in sano in 95.2% of cases, and non in sano for the endocervix in 2.2% of cases and for the ectocervix in 2.6% of cases. COMPLICATIONS: Needing second surgical intervention hemorrhage rates were 1.8% during the first period (2/113) and 1.7% according to the second period (2/117). No infectious complications were reported in the two series. As for delayed and long-term complications, incomplete stenosis rates (uterine cervix permeability up to n degree 3 Hegar dilatator) reached respectively 3.5% of cases (4/113) and 1.7% (2/117); complete stenosis rates were 2.6% (3/113) and 0% (0/117). RECURRENCES: Nine recurrent cases (5.9%) were divided into two low dysplasia, four moderate dysplasia, one severe dysplasia, one epidermoid carcinoma in situ and one infiltrating carcinoma. CONCLUSIONS: The less aggressive possible choice of a conservative therapy allows not only young patients to conserve their fertility but also to preserve cervical anatomy and to facilitate diagnosis of a recurrent case. The decrease in the complications rates that we have allocated first to the use of carbon dioxide laser and second to the pulsed beam emphasize quality research throughout our experience.

Adenocarcinoma↗