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PubMed1976

[Results of the conservative management of carcinoma in situ of the uterine cervix by conization (author's transl)].

From 1958 to 1969 conizations for carcinoma in situ of the uterine cervix were carried out in 683 women. In 523 cases no further therapy was instituted immediately. Step serial sections of the conization specimens showed that carcinoma in situ was completely removed in 346 (66.2%) of the cases. In 177 (33.8%) of the cases, the excision of the atypical epithelium was incomplete or not with certainty complete, by the conization. Of these patients 43 women were older than 45 years. Follow-up examinations after conization with complete removal of all atypical epithelium showed that only one case showed again a pathological epithelium. In this case, hysterectomy for an adnexal tumor four years after conization showed a mild dysplasia of the endocervix. Follow-up examination of the cases with incomplete or possibly incomplete conization showed no further pathological finding in 90% of the cases. In 19 (10.7%) of the women, atypical epithelium reappeared after varying lengths of follow-up. In 4 women, invasive carcinoma had developed and in 2 women, microinvasive carcinoma had developed. Following operative treatment, further follow-up examinations in these patients were negative. Conization of the uterine cervix with complete removal of all atypical epithelium is shown to be adequate treatment for carcinoma in situ. In cases with incomplete or not with certainty complete removal of atypical tissue by conization, individual follow-up is necessary. If further pregnancies are desired the small risk of observation is justifiable. Diagnosed persistence of atypical epithelium is an indication for a hysterectomy. Hysterectomies are also necessary if the patient does not comply adequately with the follow-up protocol.

Adult↗
PubMed2001

Value of human papillomavirus deoxyribonucleic acid testing after conization in the prediction of residual disease in the subsequent hysterectomy specimen.

OBJECTIVE: Our aim was to evaluate human papillomavirus deoxyribonucleic acid testing after conization in predicting residual disease in the subsequent hysterectomy specimen. STUDY DESIGN: A prospective study was conducted on 75 patients with grade 3 cervical intraepithelial neoplasia who had cone margins or endocervical curettage specimens showing disease and who elected to undergo hysterectomy after conization. All patients underwent high-risk human papillomavirus deoxyribonucleic acid testing by the Hybrid Capture II (Digene Corporation, Gaithersburg, MD) system before conization and at the time of hysterectomy (within 2-7 weeks after conization). The presence of human papillomavirus deoxyribonucleic acid in cells obtained by endocervical brush before hysterectomy was correlated with residual disease in the hysterectomy specimens. RESULTS: Of the 92 patients enrolled, 75 were eligible. Of these 75 patients, 52 (69.3%) had persistent human papillomavirus deoxyribonucleic acid after conization, and 27 (36.0%) of the 75 patients had residual cervical neoplasia in the hysterectomy specimens. Those with negative results for human papillomavirus deoxyribonucleic acid after conization were all (23/23) without residual disease in the uterus (100% negative predictive value). All those who had residual disease (27/27) had positive results for human papillomavirus deoxyribonucleic acid at the time of hysterectomy (100% sensitivity). Postconization human papillomavirus deoxyribonucleic acid status (odds ratio, 4.000; 95% confidence interval, 1.531-10.449; P =.005) and grade of dysplasia after endocervical curettage (classified as grade 2 cervical intraepithelial neoplasia or less severe disease vs grade 3 cervical intraepithelial neoplasia: odds ratio, 6.612; 95% confidence interval, 2.837-15.409; P =.0002) were significantly associated with residual tumor in the uterus. CONCLUSIONS: This prospective study confirms an excellent sensitivity and negative predictive value of human papillomavirus deoxyribonucleic acid testing after conization in predicting residual cervical neoplasia. A strategy of managing patients with grade 3 cervical intraepithelial neoplasia, based on postconization human papillomavirus deoxyribonucleic acid findings and endocervical curettage results, is proposed.

Adult↗
PubMedDate not supplied

Cold knife conization and loop excision for cervical intraepithelial neoplasia.

AIMS AND BACKGROUND: Our aim was to investigate whether loop excision is an acceptable alternative to traditional cold knife conization of the cervix. PATIENTS AND METHODS: 240 with cervical intraepithelial neoplasia (CIN) were randomly assigned to loop excision (n = 120) or cold knife conization (n = 120). Success and complication rates of both methods were analysed. RESULTS: 100% of cold knife conization and 98% of loop excision surgical specimens were positive for dysplasia. The rate of complete resection was 91% in the cold knife and 82% in the loop excision group, but histologic confirmation of residual CIN was obtained in only 2 (1.7%) women after cold knife conization and in 5 (4.2%) after loop excision. Loop excision cones were significantly shallower than those obtained by a cold knife. Secondary surgical procedures due to early hemorrhage were performed in 9 (7.5%) patients treated with cold knife conization and in 8 (6.7%) treated with loop excision. Elevated temperature postoperatively was observed in 16.4% of patients after cold knife conization and in 13.9% after loop excision. There were no other postoperative complications. CONCLUSIONS: The results suggest that cold knife conization and loop excision are comparable and equally effective diagnostic and therapeutic procedures for CIN.

Adult↗
PubMed1997

Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease.

OBJECTIVE: To determine the interpretability and significance of the traditional factors used to predict residual dysplasia in hysterectomy specimens after loop conization. MATERIALS AND METHODS: Loop electrosurgical cervical conization was performed on 372 patients. Ninety three women had a hysterectomy within 6 months of the loop conization. Residual disease was defined as cervical intraepithelial neoplasia or cancer in the hysterectomy specimen. RESULTS: Of the 93 patients having a subsequent hysterectomy, 36 (38.7%) has residual disease in their hysterectomy specimen. The mean age of the patients with residual disease in the post loop conization hysterectomy specimen was 42.22. The mean age of those free of residual disease was 29.42. By multivariate analysis, dysplasia involving the ectocervical margin (p = 0.34) and the endocervical margin (p = 0.35) was not predictive of disease in the hysterectomy specimens. Endocervical curettage (p = 0.005), glandular involvement (p = 0.01), loop conization pathology findings (p < 0.05) and cytological examination (p < 0.001) were predictive of residual dysplasia. CONCLUSIONS: Cytological reports, increasing age, severity of disease, gland involvement and endocervical curettage were the only factors that accurately predicted residual dysplasia. The presence or absence of dysplasia in the loop conization, ectocervical margin and endocervical margin was not predictive of residual dysplasia in post loop conization hysterectomy specimens.

Adult↗
PubMed1991

Conization for CIN associated with human papillomavirus infection.

We report results of follow-up by PAP smears and colposcopy in 116 women treated since 1981 by conization for cervical intraepithelial neoplasia with human papillomavirus infection (HPV-CIN). The mean follow-up time was 31.9 (SD 19) months. Preoperative diagnosis was HPV-CIN II (with extension into the endocervix) in 11 cases and HPV-CIN III in 103 cases; two diagnostic conizations were performed. The histological examination of the cone biopsies showed complete excision of CIN in 109 cases (94%). Three patients underwent hysterectomy after conization; one had microinvasion in the cone biopsy, one had suspicion of microinvasion and one had non-radical conization. Three patients (2.6%) were lost to follow-up. After excluding these six patients the primary cure rate of HPV lesions (normal cytological and colposcopical finding after conization) was 82.7%. Four patients (4.6%) had residual CIN after conization. During the follow-up 15 patients had recurrence of HPV infection, only one had HPV-CIN I. HPV 16 was the most common HPV type (56/116, 48.2%) in the conization group and also in the recurrent cases (9/15, 60%). The results support the role of HPV 16 in cervical carcinogenesis.

Adult↗
PubMed1979

Pregnancy complications following conization of the uterine cervix (I).

The literature on the course of pregnancies following conization of the uterine cervix has been studied. It is demonstrated that an evaluation of the possible effect of conization upon subsequent pregnancy should be based upon a comparison of either pregnancies before and after conization or upon a comparison between pregnancies in women with a previous conization and in a control group of women without conization. In both cases the possible influence of conization can be evaluated only if the patient material is described as regards age, parity, number of previous pregnancies, smoking habits, etc., factors which may all influence the course of pregnancy. None of the previous publications have described the patient material sufficiently, and most studies have not tried to set up control groups. Due to these deficiencies we do not find it justified that conization leads to reduced fertility, increased frequency of spontaneous abortion, nor to increased perinatal mortality. An increased prematurity rate may not be rejected, however, but this point has not been adequately evaluated in the previous papers.

Abortion, Induced↗
PubMed1981

Severe cervical dysplasia. Control by biopsies or primary conization? A comparative study.

During the period 1967-75 severe cervical dysplasia was diagnosed in 87 consecutive cases by means of colposcopically directed biopsies of the portio and by cervical curettage. Thirty-eight of the patients were treated, 3-6 weeks after diagnostic biopsy, by conization (conization group) and subsequently followed with smears and colposcopy. The remaining 49 patients (the biopsy group) were followed up at regular intervals by colposcopically directed biopsies of the portio and cervical curettage. The follow-up period for all 87 patients ranged from 9 to 106 months, mean 47.6 months. The groups were comparable with respect to the most important epidemiological factors. During the follow-up period progression to carcinoma in situ and to microinvasive carcinoma was found in 57.1% of the biopsy group but in 0% of the conization group. Of the whole material, 69 patients had conization (the 38 patients of the conization group plus 31 of the biopsy group). In 3 cases (4.35%) the cone diagnosis was 1 grade more serious than the biopsy diagnosis. The mean transit time of progression from severe dysplasia to CIS/MIC was 12-15 months. It is concluded that severe dysplasia is a rapidly progressing state which can be safely diagnosed by colposcopically directed biopsies of the portio and cervical curettage and effectively treated by conization. In view of the fact that not less than 32.7% of the cases with severe dysplasia in the biopsy group regressed during follow-up, we recommend that the diagnosis be established by portio biopsies and cervical curettage, twice with an interval of 3 months to restrict the number of superfluous conizations.

Biopsy↗
PubMed2001

Negative predictive value of human papillomavirus test following conization of the cervix uteri.

OBJECTIVE: The goal of this study was to determine/evaluate the negative predictive value of human papillomavirus (HPV) testing following conization of cervix uteri. METHODS: A prospective analysis was undertaken on 79 cone biopsies of women with high-grade lesions (cervical intraepithelial neoplasia (CIN) III). HPV testing was performed on cervical smears before and after conization. We correlated the margin status (defined as positive cone margin or endocervical curettage status) and positive conization HPV status with the residual disease in a hysterectomy specimen. A Digene II kit was used to perform HPV testing. HPV detection was done by Hybrid Capture assay. RESULTS: Of the 79 patients, 47(59.5%) had positive margins after conization. HPV testing was positive in 37 cases (78.7%) and negative in 10 cases (21.3%). Residual disease was found in 31 of 47 (66%) postconization hysterectomy specimens. No residual lesions were found in HPV-negative cases. Of the 32 cases with negative margins following conization, HPV testing was negative in 25 cases (78%) and was positive in 7 cases (22%). Among these 25 cases with negative HPV tests, no residual lesion was detected, and in 7 HPV-positive cases, only one residual lesion was found. CONCLUSION: HPV testing is potentially an effective tool in predicting residual dysplasia after conization and could potentially assist in the decision between hysterectomy and conservative follow-up in women with CIN III.

Cervix Uteri↗
PubMed2002

Adenocarcinoma in situ of the cervix: a prospective study of conization as definitive treatment.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of combination laser conization alone as definitive treatment of adenocarcinoma in situ (AIS) and to evaluate the safety of a conservative expectant strategy irrespective of cone margin status. METHODS: Sixty consecutive patients with histologically proven adenocarcinoma in situ were treated with combination laser conization from 1990 to April 2001. In 58 cases this was considered final therapy, and patients were followed for a mean period of 49 months. RESULTS: The mean age was 34.9 years. Preconization evaluation demonstrated AIS in 76.7%. In 58 cases conization was considered final therapy, and in these cone margins were involved in 15 cases. Twenty-seven patients (46.6%) were followed for more than 60 months. Totally, 4 recurrences (6.9%) were observed. One recurrence was observed in patients with involved margins (6.7%) 4 months after conization, and 3 recurrences in patients with uninvolved margins (6.9%) were registered, in 2 cases more than 5 years after conization. No case of invasive disease was diagnosed during follow-up. The mean cone height was 19 mm; 16.7% of the cone biopsies were more than 25 mm. CONCLUSIONS: Combination laser conization was an effective treatment of AIS, and an expectant follow-up schedule based on cytology was demonstrated to be safe irrespective of cone margin status after a significant follow-up period. A potential risk of overtreatment and unnecessary worrying of the patients exists if further treatment is based solely on the status of the cone margins. Only prospective studies of similar strategies will give sufficient evidence for valid recommendations concerning the management of AIS.

Adenocarcinoma↗
PubMed1999

Loop diathermy or laser excisional conization for cervical intraepithelial neoplasia.

BACKGROUND: Cervical intraepithelial neoplasia (CIN) can be managed by ablative or excisional procedures. We have compared the excision time, effectiveness, and safety of loop diathermy (loop) against laser conization. METHODS: In a prospective study in two hospital departments 222 women were randomized to loop or laser conization. Data were collected by questionnaires after operation and at two follow-up examinations. RESULTS: At department A (122 women), two physicians performed 27% of the loop and 35% of the laser excisions; at department B (100 women), the corresponding figures were 69% and 59%. Loop was quicker than laser conization in both departments (median 3-4 min versus 10-20 min), while laser conization was more time consuming in department A (median A/B = 20/10 min). Peroperative bleeding dominated during the laser procedure in both departments and complicated the loop procedure more frequently in department A. Postoperative bleeding occurred with equal frequency in the four groups (41.8%, 52.7%, 59.2%, 64.7%). At both departments, bleeding for more than two weeks was reported twice as often after laser conization (A:13.8%, B:24.2%), when compared to loop excision (A:7.1%, B:13.7%). Residual CIN was found in all of three re-conizations and in one of eight hysterectomy specimens. CONCLUSIONS: Loop was quicker than laser excision, per- and postoperative bleeding diminished, and the success rates were comparable. Physicians mastered Loop excision after a few attempts. However, the results improved, when performed by a restricted number of physicians. Histological incomplete excision indicates close colposcopic and cytologic follow-up to identify residual CIN.

Adult↗
PubMed1985

Carbon dioxide laser for combination excisional-vaporization conization.

Extensive cervical intraepithelial neoplasia may simultaneously involve large areas of the ectocervix, even extending to the vaginal fornices, as well as the endocervical canal. In such instances conventional sharp knife conization would result in virtual removal of the cervix if the surgeon wished to completely circumscribe the entire lesion. By combining a narrow carbon dioxide laser excisional conization with ectocervical vaporization, cervical intraepithelial neoplasia may be eradicated by a virtually bloodless surgical procedure and fertility may be preserved. Sixty-one combination conizations with 6 months to 4 years of follow-up are reported. In 95% of the cases biopsy demonstrated cervical intraepithelial neoplasia in three or more ectocervical quadrants, and 16% had extension of disease into the vagina. The technique of combination conization uses 20 to 30 W of power and 1/2 to 1 mm spots for excision and 10 to 15 W and 1 to 1.5 mm spots for vaporization. The average time to complete the entire procedure was 21 minutes. In three of 61 cases endocervical margins were positive; there were no instances of persistence of neoplasia at either the ectocervical or the vaginal margins. Four complications were observed, all related to delayed bleeding; however, only two patients required the placement of a suture. The volume of tissue removed by a large excisional conization is more than two times greater than that of a laser combination conization.

Adolescent↗
PubMed1992

Diagnostic value of conization of the uterine cervix in the management of cervical neoplasia: a review of 756 consecutive patients.

A review of 584 consecutive cases of conizations performed over a 15-year period showed that 320 patients (54.8%) had conizations because of the presence of neoplastic cells in the endocervical curettings. Of these patients, 268 (83.4%) had cervical intraepithelial neoplasia of various grades on conization, and 12 (3.6%) had microinvasive cancer. The remaining 40 patients had normal cervical epithelium. One hundred seven (18.3%) patients had conization because of cytological smear and colposcopy discrepancy. Seventy-six (71.0%) patients in this category had cervical intraepithelial neoplasia. Two (2.0%) had superficially invasive cancer; the remaining 29 patients had normal cervical histology. Sixty-seven (11.5%) had conizations because of unsatisfactory colposcopic evaluations. This review indicates that although conization is less frequently performed, it is still a useful tool in the management of patients with abnormal cytology in whom colposcopy evaluation cannot rule out invasive cancer.

Adolescent↗
PubMed1983

A comparison of complications of laser and cold knife conization.

A comparison was made of intraoperative and postoperative complications of laser conization and cold knife conization. Of 428 women hospitalized for cold knife conization, 23.6% had one or more complications; 14.3% had postoperative hemorrhages, 6.8% had infections, and 4.7% suffered from stenosis. Two hundred sixteen women were hospitalized for laser conization; 5.1% of them suffered complications. Postoperative hemorrhages occurred in 2.8% and infections in 2.3%. No case of stenosis occurred. Laser conization as an outpatient procedure was undertaken in 240 women; 4.2% had complications. Postoperative hemorrhages occurred in only 2.5%, infections in 1.3%, and stenosis in 0.8%. Laser conization has the same complication rate as laser vaporization and can be safely performed on an outpatient basis, thereby reducing hospital costs.

Adult↗
PubMed1984

[Evaluation of cervical conization as a definitive treatment for borderline lesions of the uterine cervix].

Therapeutic efficacy of cervical conization was examined on 93 patients with borderline lesions of the uterine cervix who underwent hysterectomy following conization. No lesions or only minimal residual lesions were found at subsequent hysterectomy when the surgical margins of cone specimens were not involved in the malignant or premalignant lesions. From these results, we concluded that cervical conization could be considered as a therapeutic procedure when the following conditions were fulfilled. Cone specimens are sufficient in size. Both endocervical and exocervical margins are negative. No malignancy is found on endocervical curettage. No abnormal cytologic findings are found after conization. Another follow-up study was performed on 69 patients who received therapeutic conization between 1971 and 1981. Among them one developed stage II cervical cancer two years after the last follow up. Two other patients had recurrent CIN in the cervix and another patient was found to have an endometrial cancer. These patients were successfully treated after early detection of the lesions by the cytological examination. From these facts, cytological examination is recommended in the follow-up after therapeutic conization.

Adenocarcinoma↗
PubMed1994

Thermal tissue damage following laser and large loop conization of the cervix.

OBJECTIVE: To compare thermal injury zones produced with laser and diathermy loop conization. METHODS: Excisional cervical specimens (cones and cervices) were obtained from 40 consecutive women who underwent abdominal hysterectomy. The subjects were assigned to have either laser or diathermy loop conization (20 in each group). The duration of each procedure was recorded. Histopathologic measurements of thermal injury zones were performed in all specimens. RESULTS: The techniques produced cone specimens of similar depth. The mean depth of thermal injury produced with laser conization in cone specimens (mean +/- standard deviation 0.49 +/- 0.16 mm) and cervical craters (0.58 +/- 0.24 mm) was significantly greater (P < .001) than the corresponding depth in cone specimens (0.22 +/- 0.09 mm) and cervical craters (0.27 +/- 0.11 mm) obtained by diathermy loop excision. The mean time of the two procedures was also significantly different (P < .001); laser conization 11 +/- 4.5 minutes and loop conization 2 +/- 1.2 minutes. CONCLUSION: For routine conization, loop diathermy causes less thermal damage to the specimen and is a faster procedure than laser.

Adult↗
PubMed1994

[Relation between cervical conization, microbial colonization and threatening preterm labor].

UNLABELLED: The relationship between prior cervical conization, the cervical microbial colonization and threatening preterm delivery was investigated in 35 women with preterm premature rupture of the membranes (PPROM), 38 women with idiopathic preterm labor and 75 normal pregnant women at 26-34 weeks of gestation. Prior cervical conization occurred with a significantly higher frequency in PPROM patients than in patients with preterm labor (p < 0.01) and normal pregnant women (p < 0.001). The prevalence of lactobacilli was lower in patients with PPROM than in patients with preterm labor (p < 0.05) and control patients (p = 0.05)--and lower in patients with prior cervical conization than in patients without prior conization (p < 0.05). All other microorganisms occurred with the same frequencies in all groups. CONCLUSIONS: Prior conization was associated with PPROM. Women with prior conization and women with PPROM had a reduced prevalence of lactobacilli in the cervix. The "absence" of lactobacilli may indicate changes in the cervical microflora, which could be of importance for PPROM.

Adult↗
PubMed1996

Loop electrocautery excisional procedure: therapeutic effectiveness as an ablation and a conization equivalent.

This study was designed to compare the effectiveness of loop excision procedures as ablation and conization equivalents, and their use in recurrent cervical high-grade dysplasia patients. We retrospectively reviewed patients undergoing loop procedures between January 1992 and April 1994. Conization equivalents were defined as procedures performed for unsatisfactory colposcopy, positive endocervical curettage, discordant cytology and histology, and cytology suggestive of invasion. Effectiveness in high-grade recurrent lesions was evaluated separately. Therapeutic failure was defined as any recurrence of high-grade dysplasia. One hundred sixty-two patients underwent loop procedures, of which 123 (75.9%) had follow-up examinations and are included. Mean follow-up was 17.9 months. Seventy-six patients (61.8%) had the loop procedure performed as an ablation equivalent, 29 (23.6%) as a conization equivalent, and 18 (14.6%) for recurrent disease. Overall effectiveness was 82.1 % and for ablation and conization equivalent procedures was 82.9 and 82.8%, respectively. There was no significant difference between effectiveness when performed for initial therapy (82.9%) and for recurrent disease (72.2%) (P = 0.46). In conclusion, loop excision procedures are effective as ablation and conization equivalents and as treatment for recurrent high-grade dysplasia.

Conization↗
PubMed2001

Cervical intraepithelial neoplasia III: long-term outcome after cold-knife conization with clear margins.

OBJECTIVE: To evaluate the long-term outcome of patients with severe cervical intraepithelial neoplasia or squamous cell carcinoma in situ (CIN III) after cold-knife conization with clear margins. METHODS: A total of 4417 women (mean age 36, range 18-72 years) with histologically confirmed CIN III had cold-knife conization with clear margins at our institution between 1970 and 1994. All patients were followed up with colposcopy, cytology, and pelvic examination for a mean of 18 years (range 5-30years). RESULTS: New high-grade squamous intraepithelial lesions (SILs) (CIN II and III) developed in 15 (0.35%) patients (mean age 35, range 25-65 years) after a median of 107 (range 40-201) months. A total of 4402 (99.65%) patients (mean age 36, range 18-72 years) were free of high-grade SILs after a mean follow-up of 18 (range 5-30) years. High-grade glandular intraepithelial lesions developed in two (0.05%) patients 14 and 17 years after conization. Twelve (0.3%) patients had metachronous vulvar intraepithelial neoplasia (VIN) grade III or vaginal intraepithelial neoplasia (VAIN) grade III, and one (0.02%) patient had invasive vaginal carcinoma 10 years after conization. CONCLUSION: Cold-knife conization with clear margins was an adequate method to definitively treat CIN III.

Adolescent↗