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PubMed1992

[Cervical intraepithelial neoplasms. Persistency and recurrence after laser surgery].

Between 1983 and 1988, 402 women, with ages ranging from 18 to 73 years were treated for cervical intraepithelial neoplasia using the CO2-laser. 89 patients underwent vaporization and 313 conization. Preoperative biopsy examination showed CIN III in 214 patients. Five cases of invasive cancer were diagnosed, either preoperatively (two cases), after conization (two cases) or on both occasions (one case). At the first postoperative examination residual disease was found in 21 patients of the vaporization group (23.6%) and in 13 patients of the conization group (4.3%). Later examinations (after 5-70 months) revealed recurrence in 10 patients in the vaporization group (11%) and in 13 patients in the conization group (4.3%). Median time for recurrence was 11 months. 30 patients were treated twice or more. No case of invasive cancer was diagnosed after treatment.

Adolescent↗
PubMedDate not supplied

[Therapy of carcinoma-in-situ: comparison of methods].

This work comparatively evaluates the results of therapy for CIN (in terms of recovery persistence and relapse) in 362 women submitted to electrocauterization, laser vaporization, laser conization, diathermy loop conization, cold knife conization, from January 1980 to December 1989. Parameters as age, CIN grade, time elapsed between diagnosis and therapy, contraceptive exposition, have been considered. The results show a slight difference in the persistence and relapse rates between conization globally considered (traditional, laser, loop) and local surgery (cauterization, laser) in favour of the latter. Nevertheless the difference was too little to suggest abandoning one treatment in favour of the others. Moreover this work indicates that the results of therapy are independent from the type of contraceptive used. Furthermore, the finding of relapses during follow up only in CIN grade 2 indicates that this grade of CIN must be considered at risk, requesting adequate consideration and follow up.

Adolescent↗
PubMed1990

[The diagnosis, management and treatment results in patients with carcinoma in situ of the cervix uteri].

The authors analysed the results of 225 women with carcinoma of the uterine cervix, treated at the gynecological clinic of the National Oncological Center for a 10-year period. The mean age was 36.7 years. No complaints were found in 206 patients. Cytological Pap 3-5 was established in 221 women. Conformity between histological examination after a colposcopic-directed biopsy, conization or total hysterectomy was found in 117 patients (53.18%). Carcinoma was discovered at 0 degree in 34 patients (11.44%) only just after conization, but in 69 women the tumour was removed during a colposcopic-directed biopsy and was not found in the operation material. Treatment of 217 women was conization, of 3 women--classical total hysterectomy and of 5 patients--intracavitary brachytherapy. In 7 patients the tumour was not removed till healthy tissue, which caused reconization in one woman and total hysterectomy in 6 patients. A relapse of the disease was found in 9 patients up to 2 years after conization (6 cases with carcinoma in situ, 3--with microinvasive carcinoma). Total hysterectomy was performed in all patients. Possibility for discovery of a relapse in the form of invasive carcinoma is ruled out during systemic and continuous observation. It is possible to perform reconization in women with persistent carcinoma in situ in view of preserving their generative function.

Adult↗
PubMed1989

[Abnormal cervical cytology. Management without colposcope].

From 1980 to 1987 we analyzed prospectively 30 cases of abnormal cytology at the Hospital Civil de Guadalajara without colposcopy. We practice cervical biopsy with Schiller test and according to result we practiced cervical conization. The cytologic results analyzed were: class V 20 (66.6%), class IV 6 (20%), persistent class III 2 (6.6%) and class II with clinical lesion suspicious of cancer 2 (6.6%). From all the patients, in 12 (40%) we found invasive cancer so that we didn't practice conization; in 10 patients (33.3%) we found the same results in the biopsies that in the conization, but in 8 patients (26.6%) the conization results were worse than the biopsies. We had one cytology class V false positive.

Adult↗
PubMed1986

Morphometric analysis of dysplasia in cervical cone biopsy specimens in cases with false-negative cytology.

Conization specimens with a histologic diagnosis of cervical intraepithelial neoplasia III were reviewed with respect to cytology findings in the three months preceding conization. In 29% of the cases, one or more false-negative cytology reports preceded conization. No dysplastic cells were found on review of the false-negative cytology slides from these cases. Morphometric analysis of surface dysplasia in the conization specimens was performed to explain these findings. A statistically significantly greater surface area of dysplasia and greater spread of dysplastic cells in the endocervical canal was found in the positive cytology when compared to the false-negative cytology cases. No difference in vaginal spread of dysplasia existed between the two groups. The endocervical canal was sampled with a moist cotton swab in all of the cases. The results suggest that small numbers of dysplastic cells high in the endocervical canal may not be effectively sampled by cotton swabs in cases of false-negative cervical cytology, lowering screening sensitivity.

Adult↗
PubMed1985

Partial trachelectomy in the elderly patient with abnormal cytology.

Because of an unsatisfactory colposcopic examination, cold knife conization of the cervix is frequently required for the evaluation of postmenopausal patients with abnormal cervical cytology. With advancing age, the cervix atrophies and retracts so that conization becomes increasingly difficult and results in a tissue specimen that is frequently inadequate. Dissatisfied with the results of the standard conization procedure, the authors performed partial trachelectomy in 26 elderly patients with atrophic, retracted cervixes. The operative complications were acceptable. Twelve of the 26 patients (46%), including four with severe dysplasia and carcinoma in situ (CIS) and eight with invasive carcinoma, received additional therapy. Eleven of 14 patients (78%) with cervical intraepithelial neoplasia (CIN) had clear surgical margins; ten of these required no further therapy. The authors conclude that partial trachelectomy may be preferable to conization for the evaluation of elderly women with small, atrophic cervixes. It provides a specimen of sufficient length, so as to reduce the incidence of positive surgical margins and to decrease the need for additional therapy if no invasive neoplasia is found. The technique of partial trachelectomy is described.

Aged↗
PubMed1978

[Therapy and therapeutic results in carcinoma-in-situ- of the uterine cervix].

348 cases of carcinoma in situ are reported, which were diagnosed, without exception, by conization from 1966 to 1971. The atypical changes could be removed without leaving any detectable malignant cells in situ in 226 patients (65 per cent). These cases did not need any further therapy. In 45 cases (12,9 per cent) was doubtful if the conization could be performed without leaving malignant cells. In 77 cases (22,1 per cent) the conization was done leaving malignant cells in situ. 49 women of this group had a continued treatment, the vast majority was hysterectomized. All the other cases were strictly controlled. The 5-year healing quotient was 91,7 per cent. 7,1 per cent of the patients have not been heard of again. Only 3 patients (0,9 per cent) suffered a recurrence. They belong, without exception, to the control group in which the carcinoma in situ could not be primarily removed without leaving malignant cells in situ. The significance of an exact method of conization and a careful histotechnical perparation of the specimens in serial sections is especially pointed out. The necessity of a continued treatment by means of hysterectomy with vaginal cuff is stressed in carcinoma in situ which could not be removed without leaving malignant cells in situ.

Adult↗
PubMed1981

Role of cryosurgery in the treatment of intraepithelial neoplasia of the uterine cervix.

Six hundred five women with varying degrees of intraepithelial neoplasia of the uterine cervix were treated with 4 different modalities: 315 patients were treated with cryosurgery, 43 with electrocautery, 127 with conization, and 120 with hysterectomy. Of the patients undergoing cryosurgical treatment, 83 had cervical intraepithelial neoplasia (CIN) I (mild dysplasia), 172 had CIN II (moderate dysplasia), and 60 had CIN III (severe dysplasia and carcinoma in situ). Patients undergoing electrocautery all had either CIN I or II. Of 247 patients undergoing conization and hysterectomy, all had CIN III except for 2 with CIN II. A follow-up study revealed a failure rate of 5.5% in CIN I or II and of 15.5% in CIN III among patients with cryosurgical treatment. Following conization for CIN III, 12.5% of patients had treatment failure; no treatment failure was reported among patients who underwent hysterectomy for CIN III. Cryosurgery and conization were equally successful in treating CIN III. Cryosurgical therapy of CIN is therefore an effective means of treatment, but a precise diagnosis must be established by colposcopy and colposcopically directed biopsy before therapy. Also, restricted criteria should be used with regard to the geographic extent of the disease, and endocervical curettage should be performed as part of the evaluation of patients with CIN undergoing cryotherapy.

Adolescent↗
PubMed2004

Treatment for cervical intraepithelial neoplasia and risk of preterm delivery.

CONTEXT: It is unclear whether treatments for cervical intraepithelial neoplasia (CIN) increase the subsequent risk of preterm delivery. Most studies have lacked sufficient sample size, mixed heterogeneous subtypes of preterm delivery, and failed to control for confounding factors. OBJECTIVE: To determine whether cervical laser and loop electrosurgical excision procedure (LEEP) treatments increase risk of preterm delivery and its subtypes. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study conducted among women evaluated at a colposcopy clinic serving Auckland, New Zealand (1988-2000), comparing delivery outcomes of untreated women (n = 426) and those treated (n = 652) with laser conization, laser ablation, or LEEP. Record linkage using unique health identifiers identified women who had subsequent deliveries. MAIN OUTCOME MEASURES: Total preterm delivery and its subtypes, spontaneous labor and premature rupture of membranes before 37 weeks' gestation (pPROM). RESULTS: The overall rate of preterm delivery was 13.8%. The rate of pPROM was 6.2% and the rate of spontaneous preterm delivery was 3.8%. Analyses showed no significant increase in risk of total preterm delivery (adjusted relative risk [aRR], 1.1; 95% confidence interval [CI], 0.8-1.5) or spontaneous preterm delivery (aRR, 1.3; 95% CI, 0.7-2.6) for any treatment. Risk of pPROM was significantly increased following treatment with laser conization (aRR, 2.7; 95% CI, 1.3-5.6) or LEEP (aRR, 1.9; 95% CI, 1.0-3.8), but not laser ablation (aRR, 1.1; 95% CI, 0.5-2.4). Moreover, risk of pPROM and total preterm delivery increased significantly with increasing height of tissue removed from the cervix in conization. Women in the highest tertile of cone height (> or =1.7 cm) had a greater than 3-fold increase in risk of pPROM compared with untreated women (aRR, 3.6; 95% CI, 1.8-7.5). CONCLUSIONS: LEEP and laser cone treatments were associated with significantly increased risk of pPROM. Careful consideration should be given to treatment of CIN in women of reproductive age, especially when treatment might reasonably be delayed or targeted to high-risk cases.

Cervix Uteri↗
PubMed2003

[Management of cervical intra-epithelial neoplasm during pregnancy].

Approximately 30% of women diagnosed with cervical cancer are in their childbearing years. Prenatal care provides an excellent opportunity for cervical cancer screening. The incidence of abnormal Pap smear has been reported in 5-8% of pregnant women. But we must know that Pap smears have cytologic modifications because of pregnancy. All abnormal smears have to be referred to colposcopic examination. The squamocolumnar junction is visualized in almost 100% of cases. The sensitivity of colposcopy is nearly 87% with complete concordance in 72.6%. Colposcopically directed biopsies have a good correlation with the final diagnosis with very minimal risks for both mother and fetus. The high rate of complications (hemorrhage, abortion, premature labor) and residual lesions in half of cases do not encourage conization during pregnancy. The final treatment is carried out after delivery. The only absolute indication for conization in pregnancy is to rule out microinvasive disease or make the diagnosis of invasive carcinoma when such a diagnosis will alter the timing of delivery but also when there is a no satisfactory colposcopy and a high-grade Pap smear. In these cases conization is performed for diagnostic and not therapeutic purpose. We must be aware of the high rate of loss of follow-up (6-33%).

Adult↗
PubMed1998

Indications for cone biopsy: pathologic correlation.

OBJECTIVE: Our purpose was to determine the ability of different indications for cone biopsy to predict the presence of disease in the cone specimen and the utility of conization for low-grade disease. STUDY DESIGN: The records were reviewed of all patients who had an excisional cone biopsy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding cytologic studies, visualization of the transformation zone, colposcopically directed biopsy, and endocervical curettage. The indications for the cone procedure were grouped as being for treatment (biopsy-proved disease) (indication A), discrepancy between cytologic and histologic diagnoses (indication B), positive endocervical curettage results (indication C), and transformation zone not fully visualized (indication D), and combinations of the above. RESULTS: Two thousand nine hundred sixty-nine records were reviewed. Of these, 604 had cone biopsies. Three hundred twenty-three of 355 (91%) cone biopsies done for indication A alone had disease on the cone specimen (defined as any grade of dysplasia or condyloma). Forty of 47 (85.1%) cone biopsies done for indication B alone had disease of the cone specimen. Forty-three of 46 (93.5%) cone biopsies done for indication C alone had disease on the cone specimen. Ninety-one cone procedures were done for a combination of indications A and D, with 87 (95.6%) showing disease on the cone specimen. Thirty-one procedures were done for a combination of indications B and D, with 25 (80.6%) showing disease on the cone specimen. Cone procedures were done on 32 women for a combination of indications C and D, and 30 (93.8%) had disease on the cone specimen. Two cone procedures were done because of the colposcopic appearance alone; one had high-grade disease on the cone specimen. Age did not help to predict the likelihood that disease would be found on the cone specimen. The data were then reanalyzed to determine the likelihood of finding high-grade disease (cervical intraepithelial neoplasia grades 2 or 3 or invasive cancer) on the cone specimen. Overall, those with preoperative high-grade cytologic or histologic characteristics (cervical intraepithelial neoplasia grades 2 or 3) were much more likely to have high-grade disease (277/371 [74.7%]) than were those with preoperative low-grade cytologic or histologic characteristics (condyloma or cervical intraepithelial neoplasia grade 1) (49/233 [21.0%]) (p < 0.001). CONCLUSION: Neither age nor the preoperative grade of disease are good discriminators of the likelihood that disease will be found on a conization specimen. However, patients who have high-grade disease on the preoperative evaluation are much more likely than those with only low-grade disease to have high-grade dysplasia or cancer on a subsequent conization.

Adolescent↗
PubMed1999

Decision-making in the colposcopy clinic--a critical analysis.

OBJECTIVE: To consider the omission of several diagnostic steps from the management of patients with high-grade squamous intraepithelial lesion (SIL) by analyzing the role of each step on the choice of treatment. STUDY DESIGN: Each diagnostic procedure was correlated to the treatment and outcome in 87 women with high-grade SIL. Treatments considered were large loop excision of the transformation zone (LLETZ) cold knife conization, and CO2 laser vaporization. RESULTS: Unsatisfactory colposcopy (P< or =0.01) and positive endocervical curettage (ECC) specimen (P< or =0.01) were essential for choice of treatment. CIN2 diagnoses of the preoperative cervical biopsy were rediagnosed as CIN3 based on the surgical specimen in 57% of the cases. The margins of 33 and 23% of surgical specimens removed by LLETZ or knife conization, respectively, displayed CIN involvement. Forty and 47% of these patients, respectively, later developed recurrent CIN. CONCLUSIONS: Omission of colposcopy and ECC could have resulted in sub-optimal treatment in many cases. Excision by LLETZ or knife conization is recommended for cases of CIN2 and CIN3. Follow up is imperative for patients with involvement of the margins.

Adult↗
PubMed2003

Microinvasive squamous carcinoma of the cervix: treatment modalities.

Patients with FIGO stage IA1 squamous cell carcinoma of the cervix can be treated conservatively with simple hysterectomy or, if young and desiring to preserve their fertility, with conization only, provided surgical margins are free of dysplasia or invasive disease. When the surgical margins are involved a repeat conization should be performed. Patients with FIGO stage IA2 or stage IA1 carcinoma with extensive lymph vascular space invasion benefit from a modified radical hysterectomy with pelvic lymph node dissection. If preservation of fertility is an issue, then conization with extraperitoneal or laparoscopic pelvic lymphadenectomy can be performed. Alternatively, radical trachelectomy with pelvic lymphadenectomy may be a safer procedure. Individualization of therapy based on an exhaustive pathological evaluation of an adequate cone biopsy specimen is of paramount importance for treatment planning and disease control.

Adult↗
PubMed1998

Adenoid basal epitheliomas of the uterine cervix: a reevaluation of distinctive cervical basaloid lesions currently classified as adenoid basal carcinoma and adenoid basal hyperplasia.

A series of 12 adenoid basal carcinomas and three adenoid basal hyperplasias of the cervix were analyzed. The ages of the patients with adenoid basal carcinoma ranged from 30 to 91 years with a mean of 71 years. Pap smear results for 11 of 12 (92%) were abnormal. Almost all patients were asymptomatic. None had a gross cervical tumor. All tumors had typical histologic features of adenoid basal carcinoma, with various degrees of squamous differentiation. Depth of tumor invasion ranged from 2 mm to 10 mm (mean, 4.3 mm; median, 3.7 mm), exceeding 3 mm in six tumors (50%). Tumor volume was >500 mm3 in four tumors (33%). An associated neoplastic squamous lesion was present in 92% of patients, including high-grade cervical intraepithelial neoplasia in 10 cases and microinvasive squamous cell carcinoma in one. Treatment was predominantly surgical, usually after some form of cervical conization; conization alone was performed in three patients. Lymph nodes were removed in five patients; none of 104 nodes had metastases. No recurrence of tumor developed in any patient. Nine patients were alive without disease after 4 to 82 months (mean, 30 months), and three died without disease after 24, 63, and 87 months. The three patients with adenoid basal hyperplasia also were asymptomatic and did not have a gross cervical lesion. Pap smear results for two patients were abnormal. The adenoid basal hyperplasias were incidental, very superficial lesions that resembled small adenoid basal carcinomas. Generally, they were attached to the squamous or endocervical mucosal epithelium; all were less than 0.5 mm in depth. Treatment was hysterectomy in one patient and conization in two. Follow-up was short but uneventful. Our findings, together with those previously reported, indicate (1) adenoid basal carcinoma with typical histologic features is not a malignant neoplasm in that it typically presents in asymptomatic women, usually is discovered after an abnormal Pap smear result due to cervical intraepithelial neoplasia, does not produce a grossly visible lesion, has never metastasized to regional lymph nodes or elsewhere, and has never itself caused death; (2) rare, histologically atypical tumors with distinctly malignant features should not be regarded as adenoid basal carcinoma; and (3) adenoid basal hyperplasia probably is a small adenoid basal carcinoma. We propose the term "adenoid basal epithelioma" to replace adenoid basal carcinoma and adenoid basal hyperplasia, because it better describes the clinicopathologic features of these distinctive lesions and their excellent prognosis and may reduce the likelihood of unnecessarily aggressive treatment.

Adult↗
PubMed2001

Adenocarcinoma in situ and early invasive adenocarcinoma of the uterine cervix.

As data continue to accumulate, the clinical characteristics of preinvasive and early invasive glandular cervical neoplasia are becoming progressively better defined. Cytologic screening for these lesions is imprecise; however, modifications to current classification systems may improve the overall accuracy. All glandular abnormalities on the Papanicolaou smear, nevertheless, require judicious evaluation and careful follow-up. Cervical conization is the most definitive means of diagnosing adenocarcinoma in situ (ACIS). Because ACIS has been thought to represent a multifocal process, with negative conization margins having limited predictive value, conservative management protocols have been difficult to endorse. Several large studies now indicate that the surgical margin status may be a more reliable indicator of true disease clearance than previously thought. For young patients desiring to maintain reproductive capacity, ACIS appears to be safely managed by cold-knife conization combined with diligent surveillance. Early invasive adenocarcinoma of the uterine cervix is associated with an excellent prognosis, and recent data suggest that radical surgery may be unnecessary.

Adenocarcinoma↗
PubMed2000

Reasons for improper simple hysterectomy in patients with invasive cervical cancer in the northern region of Thailand.

OBJECTIVE: To determine the reasons for improper simple hysterectomy in the presence of invasive cervical cancer. METHODS: The medical records of 70 patients who had undergone simple hysterectomy in the presence of invasive cervical cancer and were referred to Chiang Mai University Hospital between January 1991 and December 1998 were reviewed. RESULTS: Approximately half of the patients presented with abnormal vaginal bleeding. Failure to perform a Papanicolaou smear before the operation accounted for 35.4%. Normal pelvic examination in which no gross invasive tumor was observed accounted for 59%. The most common indications for inappropriate operation was cervical dysplasia. The reasons for inappropriate simple hysterectomy included lack of preoperative cervical cytology (22.8%), incomplete evaluation of cervical dysplasia or microinvasion on biopsy (21.4%), false-negative cervical cytology (18.6%), failure to perform an endocervical curettage following conization (8.6%), emergency hysterectomy (8.6%), failure to perform indicated conization (5.6%), errors in colposcopic examination (4.3%), incomplete evaluation of an abnormal cervical cytology (1.4%), failure to perform endocervical currettage following loop conization (1.4%), failure to review slide (1.4%), failure to check the pathology report (1.4%), failure to biopsy a gross cervical lesion, and skipped lesion in upper part of the endocervix (1.4%). One case of invasive disease was missed for unknown reason. CONCLUSION: Most cases of inappropriate hysterectomy resulted from deviation from guideline for cervical cancer detection. Preoperative Papanicolaou smear and strict adherence to the well-established diagnostic protocol for patients with an abnormal smear are advised to prevent such occurrence.

Adult↗
PubMedDate not supplied

The immediate postconization endocervical smear: evaluation of its utility in the detection of residual dysplasia.

OBJECTIVE: To determine the diagnostic value of obtaining an endocervical smear for cytologic examination immediately following cervical conization (by either the loop electrosurgical excision procedure or large loop excision of the transformation zone) in the detection of residual squamous dysplasia. STUDY DESIGN: Thirty-eight cases were identified in which cervical conization was immediately followed by endocervical sampling (most commonly using a brush) and smear. RESULTS: Twenty-one of the 38 postconization endocervical smears (55%) were either unsatisfactory or sub-optimal for evaluation due to cellular distortion (i.e., cautery artifact), degeneration or obscuring blood. Histologic in evaluation showed negative endocervical margins in 32 cases (84%) and positive endocervical margins in 6 cases (16%), including both low and high grade squamous intraepithelial lesions. The endocervical smears in the 32 cases with a negative surgical margin did not demonstrate evidence of dysplasia. However, in the six cases with histologically positive margins, postconization endocervical smears also failed to identify any evidence of dysplasia. CONCLUSION: Immediate postconization endocervical smears do not appear to be useful for the detection of residual disease in patients undergoing conization for squamous dysplasia of the cervix.

Adolescent↗
PubMed1999

The use of carbon-dioxide laser surgery in the treatment of intraepithelial neoplasia of the uterine cervix.

From October 1989 to June 1997, 1841 patients (pts) suffering from different diseases of the lower genital tract have been treated with CO2 laser surgery in our Institution: among them, 782 were affected by cervical intraepithelial neoplasia (CIN). All pts underwent CO2 laser procedure for CIN after adequate colposcopic evaluation of the entire lower genital tract, colposcopic guided biopsy of the lesion, adequate pre-surgical work-up for possible infectious and coagulation associated disease. In 736 (94.1%) pts, the procedure was performed on an ambulatory basis while 46 pts (5.9%) were admitted for 1 or 2 days. A CO2 laser Sharplan 55 associated to a Zeiss operative colposcope was employed. The preoperative diagnosis of the 782 pts treated for CIN was 297 CIN1, 255 CIN2, 171 CIN3 and 59 CIS. Mean age was 33.6 years without statistical difference among the grade of disease: 605 pts underwent laser vaporization according to specific selection criteria. The depth of cervical destruction was less than 6 mm in 26 cases, between 6 and 10 mm in 549, between 11 and 15 mm in 157, more than 15 mm in 50 pts. 742 procedures were performed under local anesthesia and pain was absent in 667 pts. (89.9%), mild in 51 (6.8%), moderate in 19 (2.5%) and severe in 5 (0.7%). Intraoperative bleeding was severe in 30 pts. (3.8%), moderate in 77 (9.8%), mild in 204 (26.1%) and absent in 471 (60.2%). The conization procedure was shown to have a higher risk of bleeding but no direct relation was observed with the depth of cervical destruction. Late complications were scarce: 1.3% of late hemorrhages, 1.4% of stenosis of cervical external orifice and cervical endometriosis in 0.3%. In 76 pts (42%) of the 177 conizations the final pathology report was in accordance with the previous biopsy, in 56 (30.9%) a lower grade of CIN was observed, in 53 (29.3%) a worse grade of the lesion was retrieved. Among these latter pts. 10 showed a microinvasive and 2 an invasive cancer: both the invasive but only 3 of the 10 microinvasive cancer pts underwent a surgical procedure (2 radical and 3 extrafascial hysterectomies, respectively). After a mean follow up of 37 months our incidence of recurrence is 2.3% (18 pts): 5 CIN1, 7 CIN2, 3 CIN3, 2 CIS and 1 microinvasive disease. In 78% of the instances the recurrence has occurred within the first year of follow up. All 18 recurrences were successfully treated with further vaporization in 8 cases, conization in 9 and hysterectomy in 1. 93 term pregnancies occurred in 83 pts after CO2 laser treatment of CIN. No cervical incompetence occurred (no cervical cerclage employed) while the incidence of spontaneous abortion was not statistically significant. 82 pregnancies were delivered vaginally without significant variation of labor phase duration. The incidence of caesarian section (11.8%) was lower than the mean incidence in our Institution. These data confirm the successful complete restitutio ad integrum of the cervix after an adequate CO2 laser surgical procedure without any further risk of cervical incompetence, premature delivery or premature rupture of membranes. The use of CO2 laser surgery is recommended as modality treatment of choice in the management of cervical intraepithelial neoplasia.

Adult↗