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PubMed2007

[Pathoanatomical preparation and reporting for dysplasias and cancers of the cervix uteri: cervical biopsy, conization, radical hysterectomy and exenteration].

A careful macroscopic description with selection of representative tissue for histological examination is required for quality assurance, for assessing prognostic factors and for answering legal questions in (pre)cancerous lesions of the cervix uteri. Exact and standardized gross inspection and preparation are decisive for the quality of the histopathological statement. The extent of cervical carcinomas should be given in three dimensions, including the relative depth of invasion into the cervical wall. The report should include size, type (according to the WHO classification) and grading of the tumor, the presence of lymphatic as well as blood vessel invasion and perineural involvement. The statement for resection margins should include the vaginal, parametrial, rectal and vesical directions. It is also mandatory to document the number of lymph nodes with metastatic disease in relation to the total number of nodes investigated. The staging should follow the TNM system. In the handling of conisation specimens, it is important to appropriately document localization, horizontal expansion, depth of invasion including microinvasion of any dysplastic or malignant lesions. Clockwise dissection of the conisation specimen, total submission, and step sections are recommended. The preparation of exenteration specimens is a highly skilled job: the exact tumor dimension should be given in its relation to all resected organs and structures with special focus on resection margins.

Biopsy↗
PubMed1984

Laser cylindrical excision to replace conization.

This report describes the procedures and results of two techniques, which were developed by the senior author (V.C.W.), for eliminating cervical intraepithelial neoplasia involving, to some degree, the endocervical canal. These are excision by carbon dioxide laser of a tall cylinder of tissue for pure endocervical lesions and shallow excision of a similar specimen followed by peripheral vaporization. In 364 consecutive referred cases one of these two procedures was performed. A total of 15.9% of patients required attention for bleeding; most cases were managed in the clinic. Near-normal tissue mass and a squamocolumnar junction at the os were observed during 3 to 60 months of follow-up. In 95.9% of cases, over half of which were grade 3 cervical intraepithelial neoplasia, normal cytologic and colposcopic findings were demonstrated after one laser procedure. A repeat laser procedure was used to eliminate persistent disease identified at 3 or 6 months. Five hysterectomies were performed. These procedures appear to be therapeutically effective, appear to preserve organ function, and allow regeneration of cervical mass.

Adenocarcinoma↗
PubMed1994

Incomplete excision of CIN in conization: further excision or conservative management?

The aim of this study was to investigate the experience of the further management in 112 cases with histological diagnosis of incomplete excision of CIN in cone biopsy. Two groups of women were studied. The women in the first group (n = 78) had a second excision while the women in the second group (n = 34) underwent conservative management with cytology and colposcopy. The histologic, cytologic and colposcopic findings in the women of both groups were compared. From the first group 38% had a second cone, 62% an hysterectomy; in 5 cases the second cone was followed by hysterectomy and the histology was negative in 75% and 65%, respectively. No indication of residual disease was found within 2-10 years of follow-up in any of the women in the second group. According to our study and being aware of the natural history of CIN, we can conclude that the decision for further excision should not be based exclusively on the histology report of involved margins, but should only be taken after careful cytological and colposcopic selection of the cases.

Adult↗