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Conization of the cervix: not an innocous procedure.
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Cervical carcinoma in situ-the role of radical conization.
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Cold knife conization of the cervix: a simple tourniquet suture for hemostasis.
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[Technic, advantages and dis-advantages of conization of the cervix uteri].
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Cold conization of the cervix: practical technic for maximum hemostasis.
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[Our histological technic for the preparation of conization tissue, the whole uterus and the uterus with attached parametrium].
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[Conization of the cervix uteri in 120 women].
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[Indications for therapeutic conization and for total hysterectomy in presence of an epithelioma of te cervix].
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[Effect of electro-conization involving the vaginal part of the uterine cervix on cervical mucus parameters].
Parameters of cervical mucus and its penetration by spermatozoa were evaluated in 36 women prior to and after conisation of the vaginal part of uterine cervix. After the procedure: complete absence of fecund mucus was revealed in 9 women (25% of cases); in 23 the mucus parameters and the penetration test results were not significantly changed (63.8% of cases) and 4 women became pregnant (11% of cases). The results of studies indicate that in the majority of cases this procedure fails to influence the parameters of mucus, although in a part of cases it may lead to its complete disappearance.
[The role of outpatient conization with a diathermy loop in the diagnosis and treatment of CIN].
The directed punch biopsy has a relevant role in the diagnosis of the CIN, mainly because of its simplicity. It is however advisable to take into account that it doesn't always reveal the exact histological degree of the cervical lesion, to the point of underestimating the invasive carcinoma. It is thus recommended, when atypical colposcopy and/or CIN2-CIN3 are diagnosed by directed punch biopsy, to define the diagnosis by preliminary large loop diathermy, also in those cases where a simple hysterectomy, because of a combined pathology, is being planned.
Preterm birth and intraamniotic infection with Candida albicans in a woman with previous cervical conization.
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[Non-invasive lesions of the cervical glands. Apropos of a study of 431 conization specimens].
431 cone biopsy specimens referred for CIN2 and CIN3 between 1984 and 1993 were reviewed with a peculiar attention paid to the possible associated endocervical glandular changes. The following features could be demonstrated: microglandular hyperplasia (17 cases), tubal metaplasia (15 cases), mesonephric hyperplasia (10 cases), in situ adenocarcinoma (7 cases), tunnel clusters (5 cases), and ectopic endometrium (4 cases). Cervical glandular atypia could not be found. A classification of the glandular lesions in uterine cervix has been proposed for an accurate diagnostic approach of lesions who could simulate carcinomatous changes.
[Loop conization of cervix uteri in gynecological practice].
Loop electrosurgical excision procedures (LEEP) in Danish office gynaecology was introduced in April 1992. This paper gives a retrospective survey of 1388 LEEP performed on 1347 patients out of an estimated number of 1483 LEEP on a nationwide basis in private gynaecological practice until the end of March 1996. At the end of the study period 46% of full-time-practices performed the operation. Indications were almost exclusively CIN. The complication rate was 10.5% in this introductory period, mainly as relatively modest postoperative bleeding. Almost all patients were preoperatively assessed by cervical biopsies and/or endocervical curettage, and information on preoperative colposcopy was obtained in 96.2% of the procedures. Unsuspected invasion was found in 2.3%. Cure-rate/LEEP was 92.5% at four-month follow-up and 89.4% at 16-month follow-up. We conclude that the method, even in the introductory period of an office setting, has acceptable complication and cure rates. Postoperative follow-up, however, is mandatory.
Cervical biopsy versus conization.
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Treatment of cervical intraepithelial neoplasia III by hysterectomy without intervening conization in patients with adequate colposcopy.
One hundred forty-four patients found to have cervical intraepithelial neoplasia (CIN) III on colposcopically directed biopsy who had completed childbearing were treated with a vaginal hysterectomy (112 patients) or abdominal hysterectomy (32 patients). The mean age of these patients was 28.6 years and the mean gravidity, 3.4. All patients had adequate colposcopy of the cervix and vagina. The transformation zone and lesion(s) were completely visualized. The uterus was submitted for histologic examination in all cases. The cervix was sectioned in a radial fashion (minimum 12 sections), and the proximal endocervix and lower uterine segment were sectioned transversely. CIN III was present in the cervix of 117 patients, CIN II in 9 patients, CIN I in 8 patients, and no evidence of residual neoplasia in 9 patients. Microinvasive cancer (1.3 mm stromal invasion without lymph-vascular space invasion) was present in one patient. After surgery, patients were seen every 3 months for 2 years and every 6 months thereafter. All 144 patients were followed up for at least 12 months, 124 patients for 24 months, 103 patients for 36 months, and 60 patients for 60 to 120 months. To date, all patients are alive and well and there have been no cases of recurrent vaginal neoplasia or cancer. These data suggest that: adequate colposcopy is an accurate method to rule out invasive cervical cancer and abdominal or vaginal hysterectomy is an effective therapeutic procedure in women with CIN III who have completed reproductive function.
The case for conservative management of "incomplete excision" of CIN after laser conization.
Three hundred thirteen laser cone biopsies were performed for cervical intraepithelial neoplasia (CIN) over a 4-year period. The mean age of the patients was 39.9 years and average cytology follow-up was just under 3 years. Six patients defaulted colposcopic review and were excluded from analysis. Of the 75 cases with CIN extending to the endocervical resection margin, 9 (12%) were found to have residual disease. Only 2 (3.6%) of 56 cases with CIN extending to the ectocervical margin had residual CIN detected. In the 176 cases in which the CIN lesion was excised completely there have been no cases of residual CIN. The overall detection of residual disease was 3.6%. Further surgery in those cases with CIN extending to the resection margin is excessive. These patients should be managed conservatively with regular cytological follow-up.
Combined colposcopy, loop conization, and laser vaporization reduces recurrent abnormal cytology and residual disease in cervical dysplasia.
OBJECTIVES: Loop electrosurgical excision of the transformation zone (LEETZ) was recently associated with relatively high failure rates. We evaluated whether the combination of LEETZ with laser vaporization is superior to LEETZ alone in reducing the rates of recurrent abnormal cytology and residual disease. METHODS: The study population included 426 women with histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2-3, of whom 289 (study group) were treated by LEETZ followed by laser vaporization of the crater base and walls and 137 (control group) were treated by LEETZ alone. All women were followed scrupulously at regular intervals for recurrent abnormal cytology and residual disease. The mean follow-up periods were 43 and 59 months for the study and control groups, respectively. RESULTS: Both groups were derived from the same community and were similar in epidemiologic characteristics and disease severity. Although the incidence of positive surgical margins was similar in both groups (10.4 and 9.5% for the study and control groups, respectively), recurrent abnormal cytology (10.2% vs 5.5%, P = 0.07) and histologic residual disease (21.4% vs 0%, P = 0.05) were more frequent among women in the control group. This applied to women with both negative and positive surgical margins. Both study and control women with positive surgical margins, especially at the endocervix, were at higher risk for recurrence. CONCLUSION: The addition of laser vaporization to LEETZ may improve outcome of both women with positive margins and women with negative margins. Our results support conservative management for all treated women, regardless of cone margin status.