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PubMed1993

[Occult cervical cancer developing after diagnostic-therapeutic conization of CIN 3].

A case of the so called occult cervical cancer which developed 2 years after the conisation performed in a 45-year old woman on account of CIN 3 has been described. Cancer was detected in the operative specimen of the removed uterus. Hysterectomy was performed on account of the progressive form of the myomas. The multiple colposcopy and cytological follow-up examination after conisation was always negative, just as the histological examination of the tissue specimen of the cervical canal. The hypothetical course of the development of the cancer has been discussed. In connection with the above findings a modification of the conisation technique, especially in older women, is suggested.

Carcinoma in Situ↗
PubMed1996

One-Session Management of Cervical Intraepithelial Neoplasia: A Solution for Developing Countries. A Prospective, Randomized Trial of LEEP versus Laser Excisional Conization

Six hundred thirty-nine patients with CIN on referral Pap were evaluated cytocolposcopically at the first visit and decided whether to be treated the same day or not. One hundred ninety-two patients (30%) were considered negative. Follow-up evidenced later appearance of CIN in five of them. One hundred fifty-three (24%) were candidates for delayed treatment due to conditions contraindicating same-day treatment. Two hundred ninety-four patients (46%) were randomly allocated in LEEP (149) or excisional laser (145) arms, and treated the same day under local anesthesia. Both arms were comparable. There were three microinvasive carcinomas diagnosed in the surgical specimen. LEEP was faster and produced less bleeding than laser, although required a mean of four slices to remove the lesion. Arterial hypertension after anesthetic infiltration was detected in 26% of cases. Two intraoperative and two delayed bleeders required surgery. The size of lesion and surgical defect were larger than those reported in the literature. Margins were involved in 8 patients (2.7%). Only 4.7% (7/149) of patients randomized to LEEP and 3.4% (5/145) with excisional laser had persistent or recurrent CIN on follow-up. Factors predisposing to failure included depth of surgical defect, grade of lesion, and operator's expertise. With this approach, 69% of patients referred for cytology of CIN were adequately managed in the first visit, which contrasts to classical management that reaches the state of treatment in 30% of patients. LEEP appears to be faster, less costly, and requires less expertise. Its use in conjunction with adequate screening is recommended for developing countries.

Journal Article↗
PubMed1977

[Diagnostic conization of the uterine cervix. II. Comparison of histological diagnoses with cytological and colposcopic tentative diagnoses].

This report presents colposcopic and cytologic misinterpretations in cases with a cervical intraepithelial neoplasia or early invasive carcinoma and benign cervical lesions and the accuracy of these two methods of screening for cervical cancer. The accuracy of the cytology and of the colposcopic impression in predicting the degree of cervical intraepithelial neoplasia and early invasive carcinoma was over 93 per cent. In patients showing benign cervical lesions the cytology is more accurate in predicting the correct histologic change with 94,2 per cent than the colposcopic impression with 63,1 per cent. The suspicious smears (Papanicolaou III) are discussed.

Carcinoma in Situ↗
PubMedDate not supplied

[Intra-epithelial carcinoma of the cervix uteri. Our experience with treatment, the role of conization].

The authors re-emphasize that the sure diagnosis of carcinoma of the cervix depends on histology; having considered a series of 15,000 smears in an article on cytological screening for carcinoma of the cervix. They show that the main prop of this histological examination should definitely be conisation. They furthermore prepare an inventory of the different possible methods of treatment of intra-epithelial carcinoma, stating for each method the advantages and disadvantages of the method. Their attitude to treatment is conservative, and they believe that conisation in every case is sufficient when complete removal of the in situ lesion is carried out whatever the age of the patient is. They state the limits of this method and define clearly the contra-indications for such a scheme of treatment, which can only be carried out routinely with the absolutely necessary cooperation of a cytology laboratory and faultless histology.

Adult↗
PubMed2006

[Cervical carcinoma in situ: a clinical and pathological analysis of 118 cases].

OBJECTIVE: To analyze the clinical characteristics and treatment of cervical carcinoma in situ. METHODS: The clinical data of 118 patients with cervical carcinoma in situ (CIS), aged 38.8 (24-77), were retrospectively analyzed. RESULTS: Cervical cytology showed that most of the lesions were cervical intraepithelial neoplasm (CINIII), high-grade squamous intraepithelial lesion (HSIL), or CIS. Most of the patients underwent colposcopic examination. All the patients underwent conization. 54% of the patients were given cold knife conization, and 46% of the patients received electric knife conization. 71 of the patients undergoing conization (60%) were followed-up. Another 40% received total hysterectomy and/or bilateral salpingo-oophorectomy. 17 cases were found pregnant after the conization. There were no differences in pathologically thorough resection and operational complication between the two surgery methods: cold knife conization and electric knife conization. Follow up study showed that conization had no effect on the subsequent pregnancy. CONCLUSION: Conization is necessary for the final diagnosis of cervical carcinoma in situ. Both cervical cytology and colposcopic examination are very important for screening of CINIII or CIS. For the young patients conization suffices, however, for the postmenopausal women or those unable to receive follow-up examination total hysterectomy and bilateral salpingo-oophorectomy should be considered.

Adult↗
PubMed1995

Management and follow-up of patients with adenocarcinoma in situ of the uterine cervix.

Management of adenocarcinoma in situ (ACIS) of the uterine cervix is controversial and cervical conization has been proposed as conservative management in patients desirous of future fertility. The efficacy of conization as treatment for cervical ACIS is unproven, as is the ideal method of follow-up. The purpose of this study was to assess the adequacy of conization of the cervix as conservative management of ACIS, and to assess the ability to detect recurrent disease. Between January 1964 and August 1993, 28 patients with a diagnosis of ACIS made by cone biopsy were seen at Memorial Sloan-Kettering Cancer Center. Initial management was as follows: total abdominal hysterectomy, 11 (39%); radical hysterectomy, 2 (7%); repeat conization, 6 (21%); and close follow-up, 9 (32%). Of the 8 patients with positive margins who underwent a repeat cone biopsy or hysterectomy, 3 had residual ACIS in the subsequent surgical specimen and 1 patient was diagnosed with invasive adenocarcinoma. Four of 10 (40%) patients with negative margins who underwent hysterectomy or repeat cone biopsy had residual ACIS. In addition, one patient whose cone margins were inevaluable was found to have invasive adenocarcinoma in a repeat conization specimen. Fifteen patients were managed conservatively with repeat conization of the cervix or close follow-up. Seven of 15 (47%) have had a recurrent glandular lesion detected after conization; 2 of these recurrences have been invasive adenocarcinoma. Since ACIS is not reliably diagnosed by cervical cytology and colposcopy, patients undergoing conservative management have been typically followed by endocervical curettage (ECC) in combination with Papanicolaou smear. In our series, the ECC was positive in only 43% of patients with glandular lesions prior to conization of the cervix. This retrospective study raises questions about the safety of therapeutic conization as conservative management of patients with ACIS of the uterine cervix and also highlights the potential inadequacy of following patients with Pap smears in combination with ECC.

Adenocarcinoma↗
PubMed1996

Radiosurgery in the management of cervical intraepithelial neoplasia.

OBJECTIVE: To evaluate the loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone-conization (LLETZ-conization) in the management of cervical intraepithelial dysplasia using high-frequency, filtered waveform energy (radiosurgery). STUDY DESIGN: Two hundred thirteen women attending the outpatient cervical colposcopy clinic with smears consistent with an epithelial abnormality, but macroscopically or colposcopically not consistent with invasive carcinoma, were included in the study. LEEP and LLETZ-conization were performed in 72 and 141 women, respectively. A matched pair group of patients undergoing cold knife conization was used for the comparison with LLETZ-conization. Using LEEP, in 83% a clear resection margin of the biopsy specimen was achieved. In this subset, diagnosis and therapy were achieved in a single visit. No complications, such as hemorrhage, occurred during the operation or postoperative period. RESULTS: Comparison of LLETZ-conization with the matched-pair group undergoing cold knife conization showed a significantly shorter duration of surgery for LLETZ-conization (mean, 10.8 vs. 16.5 minutes, P < .001). We found no differences concerning posttreatment bleeding complications (2.8% vs. 3.3%) or clear resection margins (92% vs. 86%). Patients undergoing LLETZ-conization needed significantly less analgesic (P < .01). CONCLUSION: Radiosurgical loop excision is a safe and cost-effective method in the diagnosis and treatment of cervical intraepithelial neoplasia.

Biopsy↗
PubMed1996

Pregnancy outcome after laser surgery for cervical intraepithelial neoplasia.

BACKGROUND: Little is published about obstetrical problems after treatment of cervical intraepithelial neoplasia with the C02-laser. The aim of this study was to determine the risk of low birth weight in the subsequent pregnancy after laser conization or vaporization in a follow-up study of women treated for cervical intraepithelial neoplasia (CIN). Methods. Of 319 women treated for CIN with the C02-laser in the Department of Obstetrics and Gynecology, University Hospital of Tromsø, Norway and followed for pregnancy outcome, 87 women had given birth (after 24th week) four to nine years after treatment. Sixty-five women had undergone conization and 22 women had been treated with vaporization. For each delivery, two controls matched for parity, age (+/- 3 years) and place of delivery were identified. The material was analyzed as a matched cohort study. RESULTS: A strong relationship was found between conization and low birth weight. Mean birth weight after conization was 3185 g vs 3473 g,in the control women (p=0.03). Thirteen (20%) infants from women subject to conization had birth weight less than 2500 g. Relative risk of birth weight<2500 g was 2.2 (1.04-4.5) after conization, for<2000 g and< 1500 g the risk was 3.5 (1.02-12.0) and 10.0 (1.2-85.6), respectively. Four women (6.2%) with normal deliveries prior to conization experienced one or several stillbirths after treatment. No difference in birth weight was observed for women after vaporization compared to their controls. CONCLUSION: Excisional surgery on the cervix increases the risk for low birth weight in subsequent pregnancies. Pregnant women with prior conization need careful antenatal care.

Adult↗
PubMed1996

Adenocarcinoma in situ of the uterine cervix: management and outcome.

OBJECTIVE: To retrospectively review the management of adenocarcinoma in situ of the uterine cervix, to determine the outcome of conization versus hysterectomy, and to compare the results achieved by different methods of conization. METHODS: We performed a retrospective pathology and chart review of 46 patients with cervical adenocarcinoma in situ from January 1980 to October 1994. RESULTS: Nine patients were managed during the first half of the study period and 37 were managed in the second half. The mean age of patients was 38.4 years (range 25-72). Forty-five of 46 patients were diagnosed as a result of an abnormal Pap smear, although only 19 smears indicated adenocarcinoma in situ or other glandular abnormalities. Cold knife conization resulted in a 33% rate of positive margins for adenocarcinoma in situ compared to 50% for large loop excision of the transformation zone (LLETZ). Among 24 conservatively managed patients with negative conization margins, there have been 2 (8.3%) recurrences of adenocarcinoma in situ. Among patients not undergoing hysterectomy as definitive treatment, 1 of 18 (6%) patients undergoing cold knife conization recurred, compared to 4 of 14 (29%) managed with LLETZ, despite a 63.4-month shorter mean follow-up interval for the LLETZ patients. CONCLUSIONS: Cold knife conization is associated with a lower rate of recurrence of cervical adenocarcinoma in situ compared to LLETZ. We recommend cold knife conization for patients who are not treated with hysterectomy.

Adenocarcinoma↗
PubMed1998

The pre- and postoperative value of endocervical curettage in the detection of cervical intraepithelial neoplasia and invasive cervical cancer.

OBJECTIVE: The study was conducted to evaluate the pre- and postoperative value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia and invasive cervical cancer. METHODS: Patients undergoing cervical conization were studied retrospectively to evaluate the correlation of grade of preoperative endocervical curettage and the grade of dysplasia in the conization specimen. The role of routine preoperative ECC in satisfactory and unsatisfactory colposcopy and the need for routine ECC in the detection of postoperative residual dysplasia was also evaluated. RESULTS: Results showed that 297/391 (76%) patients had ECC as part of preoperative assessment for cervical dysplasia on Papanicolaou smear. There was good association of grade of preoperative ECC and grade of conization specimen, weighted kappa-0.135 (P = 0.0003). Of 17 patients with invasive disease on conization specimen, only patients with a positive ECC had invasion at conization. None of 113 patients with a negative preoperative ECC had invasive disease on their conization specimens. The proportion of satisfactory colposcopic examinations between positive and negative ECC is not significantly different (P = 0.673). Follow-up of positive margins of resection was performed with Papanicolaou smear in only 20 patients and with Papanicolaou smear and ECC in 53 patients. In the latter group, 4% had a positive ECC with negative Papanicolaou smear (P = 0.310). CONCLUSIONS: There is good agreement between grade of dysplasia on preoperative ECC and on subsequent conization specimen. Colposcopic examination was not a good predictor of pathology in the endocervical canal. Routine ECC should be part of the preoperative assessment of an abnormal Papanicolaou smear but may be unnecessary in the evaluation for residual dysplasia.

Biopsy↗
PubMed2000

Adenocarcinoma in situ of the uterine cervix: an experience with 100 cases.

OBJECTIVE: The aim of this study was to ascertain whether cold knife conization alone for cervical adenocarcinoma in situ is safe. METHODS: One hundred consecutive patients with a histologically proven adenocarcinoma in situ (AIS) of the cervix were studied from 1970 to 1992. RESULTS: Ninety-two women presented with abnormal smears, and of these 56% contained abnormal glandular cells. Sixty-seven (74%) of 90 women who underwent colposcopy had an abnormal examination, but a glandular abnormality was suspected in only 19 (28%). In all, 80 cold knife conizations were performed. In 7, no abnormality was found following punch biopsy. The margins were free of disease in 55 (75%). The most commonly involved margin in the remainder was the apical. Conization was followed by hysterectomy in 20 women: in 8 of these the cone margins were free and residual disease was found in 2 of the extirpated uteri: as these were extramural cases, inadequate sampling could not be excluded. Of the 12 women where hysterectomy followed conization with diseased margins, 9 had residual disease in the hysterectomy specimen. The definitive therapy was cold knife conization in 56 patients, hysterectomy in 38, and electrocoagulation diathermy in 6. Follow-up of the 53 patients treated by conization alone ranging from 1 to 16 years, with a mean of 8 years (3 have been lost to follow-up) revealed no recurrence of AIS or adenocarcinoma to date. CONCLUSION: It is concluded that cold knife conization is a safe therapeutic modality, provided that the cone biopsy has been adequately sampled and the margins are free.

Adenocarcinoma↗
PubMed2003

Psychological distress of conservative and nonconservative uterine surgery: a prospective study.

OBJECTIVE: The aim of the present study is to evaluate the psychological reaction to conization before and after the operation compared to hysterectomy. To study the incidence of psychological stress related to conization, 60 women undergoing conization were compared to 40 women who had undergone hysterectomy. METHOD: Psychological disease was rated in the pre- and postoperative periods using the Symptom Questionnaire (SQ). Each patient was evaluated 2 weeks before the operation, and 3, 6 and 12 months after it. RESULTS: Both the conization and hysterectomy groups showed a significant reduction in anxiety and depression at the 3-, 6- and 12-month follow-ups compared to the preoperative period. Two weeks before surgery, 8 conization patients (19.5%) showed an anxious status, while 10 (24.3%) presented high levels of anxiety and depression. Within hysterectomy patients, the occurrence was respectively of 4 (12.9%) and 10 women (32.2%). Twelve months after surgery, of the women with preoperative depression, only four (9.7%) conization and four (12.9%) hysterectomy patients presented a negative mood status. A similar trend was present for somatic symptoms but only in the conization group, because the hysterectomy patients did not show a reduction in these symptoms from the preoperative to the postoperative period. This result could be related to the surgical menopause due to the bilateral oophoriectomy executed in more than half of the hysterectomy group. CONCLUSION: In general, the results of the present study show that the conservative and nonconservative uterine surgery determines a good psychological prognosis in the short- and long-term postoperative periods.

Adult↗
PubMed1995

Electrosurgical loop excision of the cervical transformation zone: the experience of family physicians.

BACKGROUND: Electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure for treatment of premalignant cervical disease and the abnormal transformation zone by wire loop electrodes. The purpose of this study was to describe and assess the clinical experiences and complications of family-physician-performed ELECTZ and ELECTZ conization. METHODS: Women who were scheduled for the ELECTZ or ELECTZ conization procedures were enrolled in the study between March 1992 and March 1993, inclusive. Subjects were recruited from the practices of six family physician colposcopists located at five sites. The ELECTZ and ELECTZ conization procedures were performed on patients with abnormal Papanicolaou (Pap) smears or abnormal histologic results and abnormal colposcopic findings. Procedural complications were documented. Subjects were serially assessed during the first postoperative year by Pap smears, colposcopy, and, when necessary, by biopsy to determine therapeutic cure. RESULTS: Of 198 subjects enrolled in the study, 148 women were assessed at least once in follow-up by Pap smear and colposcopy. Only 7.6% of women were defined as treatment failures by subsequent histologic assessment. Women treated by ELECTZ conization were older (32.2 vs 25.1 years, P = .02), were more likely to develop posttreatment cervical stenosis (25.9% vs 3.8%, P = .001), and were more likely to have the postoperative squamocolumnar junction positioned in the endocervical canal (32.4% vs 8.7%, P = .002) than were women treated by ELECTZ: Loop excision specimen margins demonstrated dysplasia for 27 (13.6%) subjects. Significant operative bleeding (> 25 mL) was noted in 6.8% of subjects. Histologic thermal artifact was reported for 9.6% of specimens. One case of microinvasive cancer and one case of invasive cancer were identified unexpectedly by ELECTZ conization. CONCLUSIONS: Electrosurgical loop excision of the cervical transformation zone and ELECTZ conization may be safely and effectively performed in office settings by family physicians. Complications and treatment failure rates for the ELECTZ and ELECTZ conization procedures were similar to those experienced by other clinicians.

Adolescent↗
PubMed2004

Using the cone biopsy to compare colposcopy clinics in new york and london.

OBJECTIVE: To assess whether there were significant differences in cytologic and colposcopic assessments associated with conization specimens at a colposcopy clinic in New York compared with a colposcopy clinic in London. MATERIALS AND METHODS: A retrospective histopathologic survey of patients evaluated at the Mt. Sinai Hospital Colposcopy Clinic (MSH) in New York City and the Royal Free Hospital Colposcopy Clinic (RFH) in London between January 1, 1997, and December 31, 1998, was reviewed. Study groups included all patients who underwent conization at either clinic. Referral cytologic results, colposcopic findings, and conization histologic results were compared. RESULTS: Two hundred three cases from MSH and 457 cases from RFH were reviewed. Most patients undergoing conization in either clinic were referred with Pap smears suggesting high-grade squamous intraepithelial lesions (MSH, 77%; RFH, 77%). Colposcopic biopsy was performed on all patients at MSH. At RFH, colposcopic-directed punch biopsy was not performed on 35% of the patients who would have been treated regardless of biopsy results. There is a significant difference in the distribution of cone histologic diagnosis between the two clinics (p = .02); there are proportionally more women diagnosed with high-grade disease in RFH than in MSH, where there are more normal and low-grade cone histologic results. According to the kappa coefficients, there is only slight agreement between the Pap smear cytologic results and punch biopsy with the conization histologic results for either clinic (MSH, kappa = 0.13; RFH, kappa = 0.19), with the RFH performing slightly better. CONCLUSIONS: This study shows exact agreement between cytologic and final conization diagnosis and colposcopic biopsy and final conization as 47% to 64%. Treatment decisions and outcomes are different between the two clinics, with the RFH clinic performing fewer biopsies and having more procedures yielding high-grade disease. Recommendations regarding changing colposcopic practices could best be made after a prospective study.

Journal Article↗