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At least 271 records · Page 15Linked to original sources
PubMed2003

[Evaluation of cold knife conization (CKC) on diagnosis and treatment of cervical intraepithelial neoplasia].

BACKGROUND & OBJECTIVE: Cold knife conization (CKC) is a classic diagnostic and therapeutic procedure. The authors analyzed pathological features of 62 cone specimens and determined the effectiveness of CKC on diagnosis and treatment of cervical intraepithelial neoplasia (CIN). METHODS: Comparative analysis on pathological findings of cone specimens and multiple biopsies (MB) of 62 CIN patients was performed. RESULTS: There were close similarities in pathology between CKC and MB in 44 cases (71%). Eighteen cases (29%) showed histological difference between CKC and MB; among them, 4 cases that were given a diagnosis of CIN2 or CIN3 by MB were classified into CIN3 or microinvasive carcinoma by CKC. All 62 cases were squamous epithelial lesions; 34 of them subjected to CIN3 or higher than CIN3. The lesions were mainly located in transformation zone, mostly with cervical canal involvement. Thirty cases showed equal to or more than 2 quadrants involved. Thirty-seven cases (59.7%) had histological evidences for HPV infection. Thirty-one cases(50%) had squamous metaplasia, some with variable dysplasia. Resection margin positive rates were 3.2%(>or=CIN2) and 8.1% (CIN1), respectively, lower than those by loop electrosurgical excision procedure (Leep) reported in literature. Fifty-six cases were closely followed up after operation (4 months-14 years). No recurrences were found and 3 patients had pregnancy and delivery. CONCLUSION: CKC is significantly effective and cannot be replaced by MB. Squamous metaplasia and CIN development are intrinsically correlated with each other.

Adult↗
PubMed1996

Avoiding conization for inadequate colposcopy. Suggestions for conservative therapy.

OBJECTIVE: To determine if conservative treatment can safely be offered to patients with cervical intraepithelial neoplasia (CIN) and inadequate colposcopic examination. STUDY DESIGN: We reviewed the charts of 733 evaluable cone biopsies of the cervix performed for CIN at the University of Texas Medical Branch at Galveston from January 1981 to September 1990. RESULTS: Of 371 conizations that indicated inadequate colposcopy, there were 62 cases that fulfilled all the following conditions: cytologic smear suggesting CIN 2 or less, negative endocervical curettage (ECC) and cervical colposcopic biopsy showing CIN 2 or less. Pathologic examination of the cone biopsy specimen in these 62 cases revealed no dysplasia in 29.0%, CIN 1 in 16.%, CIN 2 in 37.0%, 3 in 17.7%, and no microinvasive or invasive lesions. Pathologic examination of the cone specimens of 309 patients with any high-risk factor--smear suggesting CIN 3 or invasive disease, colposcopic biopsy showing CIN 3 or positive ECC--revealed no dysplasia in 11.9%, CIN 1 in 11.3%, CIN 2 in 16.8%, CIN 3 in 49.8%, microinvasive carcinoma in 5.5% and frankly invasive carcinoma in 4.5%. CONCLUSION: Conservative therapy may be offered to patients with inadequate colposcopy, CIN 1-2 on both biopsy and cytology, and negative ECC without over-looking either invasive or microinvasive carcinoma. With these criteria, 16.7% of patients with an inadequate colposcopy in our study could have avoided cone biopsy.

Cervix Uteri↗
PubMed1994

LLETZ is an acceptable alternative to diagnostic cold-knife conization.

Large loop excision of the transformation zone (LLETZ) provides a pathologic specimen similar to a cold-knife cone (CKC) biopsy of the cervix. One hundred twenty women with indications for a cone biopsy were evaluated with LLETZ to determine if this procedure is an acceptable alternative to traditional cold-knife conization of the cervix. All patients had LLETZ performed in the clinic under local anesthesia. An average of 2.1 slices was required to remove the transformation zone. Coagulation artifact interfered with histologic diagnosis in only 1.8% of specimens. The number of slices taken during the LLETZ procedure significantly correlated with the amount of heat artifact in the pathology specimen (P = 0.02) and interfered with the ability of the pathologist to determine complete excision of dysplasia (P = 0.03). LLETZ is an acceptable alternative to diagnostic CKC and can offer a substantial cost savings. To facilitate histopathologic interpretation, every effort should be made to minimize the number of slices and to maintain orientation of the LLETZ specimen. Endocervical curettage performed after LLETZ can identify a group of patients who are at high risk for CIN recurrence.

Adolescent↗
PubMed1975

The correlation between colposcopic grading, directed punch biopsy, and conization.

In a study group of 102 patients in whom colposcopy examinations were done, a series of 67 selected biopsies and 47 cold-knife conizations were performed. All patients had suspicious or positive Papanicolaou smears. There was a 96 to 98 per cent correlation between the colposcopic findings, biopsies, and cone specimens.

Biopsy, Needle↗
PubMed1980

Pregnancy following conization of the cervix: complications related to cone size.

A retrospective study of 88 pregnancies occurring in 77 patients after cervical conization was undertaken to compare pregnancy outcome with cone size. Cone specimens were divided into two groups. Those measuring less than 2 cm in height or less than 4 cc in volume were considered to be "small cones" and those greater than 2 cm in height or 4 cc in volume were regarded as "large cones." The over-all normal term vaginal delivery rate was 46.6%, and was found to be inversely proportional to the size of the cone. The incidence of both spontaneous midtrimester abortion and prematurity increased in direct proportion to cone size. Cervical stenosis necessitating cesarean section was, however, noted to be a complication associated with small rather than large cones. It was concluded from this study that all postcone pregnancies should be regarded as high risk, preterm complications being particularly related to large cones.

Abortion, Spontaneous↗
PubMed1992

Comparison of thermal injury zones in loop electrical and laser cervical excisional conization.

Thirty cervical conization specimens obtained by thin-loop electric excision were compared with 30 carbon dioxide laser excisional cone specimens. Zones of thermal artifact were measured with a precise stage micrometer technique calibrated to a Zeiss standard. The mean depth of coagulation at the ectocervical margin measured 0.187 and 0.164 mm for thin loop and laser, respectively. Thermal artifact at the endocervical margin was greater with electric loop (0.295 mm) than with superpulsed carbon dioxide laser (0.137 mm). The zones of thermal injury induced by both electric loop and laser made no significant impact on the interpretation of margin adequacy.

Cervix Uteri↗
PubMed1993

Five-year follow up of patients with cervical intra-epithelial neoplasia in the cone margins after conization.

Three hundred eighty-five women treated with conization due to repeated CIN I, CIN II or CIN III of the cervix uteri have been followed up for 5 years. All cones were classified according to diagnosis and status of the resection margins. A significantly greater recurrence rate of 16.2% was found in the group with neoplasia in the resection margins, in contrast to 3.9% in the group with normal resection margins. However, 83.8% (75.4-92.2%) of patients with neoplasia in the resection margins can be expected to be free of recurrence after a 5-year postoperative follow-up period. Whether the non-free resection margins were endocervical, ectocervical or both, did not influence the recurrence rate. While the prevalence of non-free resection margins increased significantly with increasing dysplasia, this could not be found with increasing age. The risk of recurrence could not be correlated with the grade of dysplasia. We conclude that neoplasia in the resection margins of the cone represents an increased risk of recurrence. Therefore, we changed the normal smear check-up with a cotton-swab to smear with cyto-brush, supplemented with colposcopy in the non-free resection margin group, but it remains to be proven that this procedure is safer.

Carcinoma in Situ↗
PubMed1990

Changes in surgical treatments: the example of hysterectomy versus conization for cervical carcinoma in situ.

From 1969 through 1985, 4584 women in the state of New Mexico were diagnosed with carcinoma in situ of the cervix. Of these women, 65.5% underwent hysterectomy while 31.1% had a conservative therapy (primarily conization). Over the 17-year period, there was a steady increase in the percentage of women receiving conservative therapies, from 11.8% in 1969 to 50.3% in 1985. Younger women, unmarried women and American Indian women were more likely to receive conservative therapy. This marked shift in therapeutic approach occurred during a time of apparent controversy as to the optimal treatment for cervical carcinoma in situ, and illustrates a rapid change in surgical practice in the absence of any controlled trials comparing the two major treatment modalities.

Adolescent↗
PubMed1982

[Pretreatment of carcinoma in situ and microcarcinoma of the cervix by conization and endocoagulation (author's transl)].

65 microcarcinomas and 189 Ca. in situ-cases were diagnosed by cone biopsy in the Department of Gynaecology and Obstetrics of the University in Kiel in the periods 1973-1976 and 1977-1980. During the first period the haemostasis of the conization crater was obtained by the conventional techniques. In 38% (microcarcinoma) and 30% (Ca. in situ) of the cases the excised uterus was free of pathological epithelium. Since 1977 we have used simple coagulation of the wound area, with endocoagulation-technique according to Semm. In the second group (1977-1980), 73% (microcarcinoma) and 45% (Ca. in situ) were histologically normal, and only one case showed remaining microcarcinoma in the excised uterus. In individual cases--such as during pregnancy or where the patient still desires to have children--the Ca. in situ with not free margins, can be treated simply with a secondary coagulation of the wound crater.

Carcinoma in Situ↗
PubMed1984

Association of condylomas with intraepithelial and microinvasive cervical neoplasia: histopathology of conization and hysterectomy specimens.

The tissues for 110 patients who received conization and/or hysterectomy following colposcopic evaluation for abnormal Pap smears were evaluated in a blind, retrospective fashion. The patients were grouped as condyloma only, dysplasia, carcinoma in situ, and microinvasion. Special note was taken of the presence of condyloma in those patients with dysplasia or greater. The mean age for each group was determined, and the significance of the differences between groups was assessed using Student's t test. Eighty-three (75%) patients showed evidence of condyloma in at least one section. The mean age of 33.0 years for this group was significantly lower (p less than 0.01). Despite the possibility that condylomas may represent a venereal infection unrelated to carcinogenesis, the association of condylomas and cervical intraepithelial neoplasia is strong. The findings in this study are consistent with the hypothesis that some forms of dysplasia represent a virally transformed epithelium.

Adult↗
PubMed1988

Sexually transmitted diseases including genital papillomavirus infection in male sexual partners of women treated for cervical intraepithelial neoplasia III by conization.

History and clinical prevalence of sexually transmitted diseases (STD), including genital human papillomavirus (HPV) infection, were studied in 60 sexual partners of 60 women previously treated for cervical intraepithelial neoplasia (CIN) III by conization. Investigations included serological and bacteriological screening, histopathology and colposcopy. A history of STD was reported by 20 men (33%), and 34 (57%) had signs of STD including genital HPV infection, 2 (3%) had a chlamydial infection, one had molluscum contageosum, 7 (12%) had genital warts and 24 (40%) had abnormal acetowhite epithelium, indicating HPV infection. The HPV lesions were principally subclinical and located on the glans penis and the prepuce. Colposcopy and application of acetic acid are essential for detection. The gynaecologist and venereologist must recognize the sexually transmitted nature of CIN, and the causal link between CIN and HPV infection. Assessment and treatment of the male sexual partner of women treated for CIN might be an essential part in disease control with the aim of preventing cervical cancer.

Cross-Sectional Studies↗
PubMed1994

Persistent cervical intraepithelial neoplasia after incomplete conization: predictive value of clinical and histological parameters.

In a group of 316 conizations performed from January 1984 to July 1991, 68 patients (22%) revealed no free margins of cervical intraepithelial neoplasia (CIN). They were divided into two groups with: 'negative follow-up' [normal cytology or less than two smears suggesting CIN I (class IIIa)] and 'positive follow-up' [at least two smears suggesting CIN I or one smear suggesting CIN II (class IIIb) or worse]. Forty-five patients (66%) fulfilled the criteria of negative follow-up. All patients with CIN I at the cone margin (18) were found in this group. The other 23 patients were in the positive follow-up group. Patients with positive follow-up were significantly younger (p = 0.04). Intervention after incomplete cone biopsy was necessary in approximately 10% (7/68) of cases. Cytology was thereby a reliable indicator for residual disease. Higher grade of CIN involved at the cone margin predicted a higher chance of positive follow-up. Semiquantitative measurement of CIN in the cone specimen showed a severe involvement of CIN II and CIN III in the positive follow-up group. In sum, our study showed that CIN I at the margin of the cone biopsy has no clinical significance. However, CIN II or III at the margin needs a careful cytologic follow-up, and appropriate action should be taken in case of cytologic abnormalities.

Adult↗
PubMed1990

Haematocervix after conization diagnosed by ultrasonography.

Haematocervix is an uncommon complication after conization. This report deals with 1 case that presented with clinical signs of progressive stenosis and was diagnosed by ultrasonography. Based on analysis of the 3 previously reported cases the pathogenesis of this condition is discussed.

Adult↗
PubMed1976

Symposium: Methods of reconstruction in tympanoplasty. IV. Conchal perichondrium as a tympanic graft with maintenance of drum conization.

Tympanoplasty reconstruction of the eardrum approached normal anatomy and function with the use of connective tissue to replace the substantia media. Perichondrium taken from the concha is preferred because it lies flat and is easy to manipulate. Grafts placed on the outer surface of the remnant tend to lateralize with loss of drum conization. Grafts placed on the undersurface of the remnant do not have this disadvantage.

Connective Tissue↗
PubMed1984

Conization of the cervix uteri. Complications in connection with plain catgut or silk suturing.

During a retrospective study on postoperative complications in 213 patients who had undergone conization, a (non-significant) reduction in the bleeding rate from 27.9% to 18.6% was found when using silk sutures (102 patients) instead of plain catgut (111 patients) for adaption of the edges of the wound (0.1 less than p less than 0.2). The reduction was most pronounced and significant in cases where bleeding had occurred during the first 4 days after surgery, the usual period for hospital stay under normal conditions. After discharge the bleeding rates were more comparable, 12.6% in the catgut group and 16.6% in the silk group. On the other hand, more cases of stenosis of the cervical canal were observed, i.e., 25.5% in the silk group and 8.1% in the catgut group (p less than 0.001). The period of hospitalization was reduced on an average by 2 days when using silk (p less than 0.001).

Adult↗
PubMed1986

Hemostasis in cold-knife conization. Effects and side effects of Glypressin, a long-acting analogue of lysine-vasopressin.

In a double-blind, randomized study, 50 patients undergoing conization were treated with either lysine-vasopressin (LVP) or its longer-acting analogue Glypressin. Bleeding during the operation and side effects were studied. The hemostatic effect appeared better with LVP than with Glypressin. One postoperative bleeding occurred in the whole series, in a patient treated with Glypressin. The effect on the general circulation, especially with respect to pallor of the skin, was less prominent with Glypressin than with LVP (with the concentrations used in this study).

Adult↗