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PubMed2000

Hybrid capture based human papillomavirus typing in cervical screening compared to cytology and histology.

INTRODUCTION: Cervical cancer is frequently associated with infection from various types of human papillomavirus (HPV) with high a oncogenic potential (high-risk types). Commercial systems for HPV typing are available, but the question as to when HPV typing should be performed has not yet been solved. OBJECTIVES: To assess the value of HPV typing in a clinical setting in a population with opportunistic screening. STUDY DESIGN: Cytology, histology and HPV status of 593 patients from a high-risk collective were evaluated retrospectively. For HPV typing, the hybrid capture (HC) system was used. RESULTS: Infection with high-risk types of HPV was associated with more severe cervical lesions. Women with PAP III or PAP IIID who were infected with high-risk HPV were at increased risk for high-grade cervical lesions (CIN III+) (p = 0.006). Conization influenced HPV status: of 63 patients who were HPV high-risk positive before conization, 4 remained positive afterwards. CONCLUSION: HC appears to be a useful system to triage women with PAP III or IIID and to detect patients with residual HPV infection after conization. However, because of high costs and no significant increase in the sensitivity of cytology, the use of HPV typing in routine cervical screening cannot be recommended in countries with opportunistic annual cytological screening.

Adult↗
PubMedDate not supplied

[Factors of recurrence of intraepithelial lesions of the uterine cervix].

MATERIAL AND METHODS: A retrospective study (1994-1996) of 282 cases of intraepithelial lesions treated in the Gynecology Services of Coimbra University Hospitals and subsequent follow-up (9-45 months). The following parameters were evaluated as recurrence factors: the patient's age, lesion degree, associated HPV infection, treatment type, safety margin in the ablative treatments and interval free of illness. RESULTS: Of the 282 cases, 72.4% (N = 204) corresponded to HSIL and 27.6% (N = 78) to LSIL. The patients' mean was 36.3 +/- 9.1 [19-67] years. The most commonly used treatment types were the LLETZ (large loop excision of the transformation zone) (76.9%) followed by CO2 LASER vaporization (16%) and finally cold-knife conization (7.1%). The safety margins were determined in 184 cases and, on average, were of 3.2 +/- 2.4 [1-10] mm. Forty-four recurrences occurred (15.6%) of which 75% corresponded to HSIL lesions (N = 33) and 25% (N = 11) to LSIL. From the total number of recurrences the association to HPV infection was found in 24 of the cases (54.5%) and 75% of these (N = 19) corresponded to HSIL. The average age in the recurrence group was 38.2 +/- 8.7 [21-53] years and 35.9 +/- 9.2 [19-67] years in the group without recurrences (p > 0.05). In the LSIL group treated with CO2 LASER (N = 32) the recurrence rate was 15.6% versus 13.3% in the group treated with LLETZ (N = 45). In the HSIL that were treated with CO2 LASER vaporization (N = 13) the recurrence rate was 23%; in those treated with LLETZ (N = 172) there were 16.2% recurrences and in the group submitted to cold-knife conization (N = 19) that rate was 10.5%. CONCLUSIONS: The total rate of recurrence was 15.6% with the greatest incidence of lesions associated to HPV (p > 0.05). Regarding the particular case of the HSIL, a great number of recurrences with the destructive treatments (CO2 LASER) was observed when compared to the ablative treatments (cold-knife conization or LLETZ).

Adult↗
PubMed2003

Negative cone biopsies. A reappraisal.

OBJECTIVE: To analyze the incidence of negative cone biopsies and evaluate the significance of the findings. STUDY DESIGN: The study population consisted of women who underwent cervical conization at a university teaching hospital from February 1996 to December 2001. Three modalities were used for conization: CO2 laser, large loop excision of the transformation zone and needle excision of the transformation zone. Negative cones were defined as those not showing evidence of human papillomavirus infection, intraepithelial neoplasia of squamous or glandular origin, or invasive disease. RESULTS: During the study period, 817 conizations were performed. Of these, 206 (25%) were negative. Less than half the patients (41.7%) had a punch biopsy that matched the subsequent cone biopsy specimen. The negative cone rate in women with a punch biopsy showing cervical intraepithelial neoplasia (CIN) 1 was 60% in contrast with those who had a biopsy indicating CIN 2-3; the latter percentage was 16.5%, and the difference was statistically significant. CONCLUSION: Close adherence to international guidelines during workup of an abnormal smear, meticulous colposcopy performed by a certified colposcopist and careful evaluation of punch biopsies by pathologists might help to decrease the negative cone rate.

Adolescent↗
PubMed2004

Operative treatment of cervical premalignant lesions and the presence of high-risk human papilloma virus as etiologic agent.

The conization as an excisional method is used as an operative treatment of high-risk premalignant cervical lesions. Early detection and removal may stop the developing process that leads to invasive carcinoma. The study presents a group of 100 women, operated with "cold knife" conization during the year 2002 at the 1st Operative Oncologic Department of the Gynecology and Obstetrician Clinic - Medical Faculty, Skopje. The operative material showed CIN 2 in 2 and CIN 3 in 31 women. In 7 of them, CIN 3 lesions were removed by punch biopsy or ECC, thus the cone showed only CIN 2. In two women out of the total of 67 with the preoperative diagnosis of CIS, CIN 3 lesions were postoperatively diagnosed. This is the result of the adequate punch biopsy during the diagnostic procedure. Three cones showed Ca microinvasivum and other 3 displayed Ca invasivum which then needed other surgical treatment. In 93 % of the women the conization had a therapeutic effect and in 7 % it was only of diagnostic value. HPV testing was made in 55 out of the operatively treated women. The most common type HPV 16 was identified in 27 % of the women. The second was HPV 31 in 25.5 %, then HPV 66 in 14.5 %, HPV 18 in 11%, HPV CP 8304 and HPV 38 in 5.5 %, HPV 58 as well as MM9 in 2 (3.6 %). The dichotomic presence of HPV 31+18 and HPV 6+16 was identified in two women. (Tab. 3, Ref: 10.)

Biopsy↗
PubMed1998

Comparative analysis of human papillomavirus detection by hybrid capture assay and routine cytologic screening to detect high-grade cervical lesions.

A commercial HPV detection test, Hybrid Capture (HC), designed to detect 14 HPV types divided into high-risk and low-risk groups, has been evaluated. A total of 1064 scrapes from 1028 unselected women attending routine cytologic screening were tested and results were compared with those of classic cytologic screening and cervical biopsies. The reliability of the test was also evaluated on 38 fresh conization samples. HPV DNA was detected in 108 women (10.5%), including 90 infected by a high-risk HPV (8.8%); 25 high-grade lesions were detected histologically, and high-risk HPV was found in 16 of these 25 women (64%), and in 27 (71%) of the 38 conization samples. The overall sensitivity of HC in detecting high-grade SIL on cervical scrapes and conization samples was 71.2%, while its positive predictive value was 17.8%. Classic cytologic screening appeared to be the most sensitive method (84%) for detecting high-grade SIL, with a positive predictive value of 91.3%. The lower sensitivity of HC limits its use for screening high-grade lesions on a large scale, even though it may be useful for reducing cytologically false-negative results. Moreover, the quantitative approach provided by the HC assay for assessment of the viral load cannot clearly distinguish among cases with or without high-grade lesions.

Adolescent↗
PubMed1995

Invasive adenocarcinoma of the cervix following LLETZ (large loop excision of the transformation zone) for adenocarcinoma in situ.

Adenocarcinoma in situ (AIS) of the cervix is a controversial entity which is being encountered with increasing frequency. Current critical issues in its management are the safety of uterine preservation in younger patients and the use of LLETZ conization. A 28-year-old patient was diagnosed with AIS and managed with LLETZ. Despite apparently negative margins of resection in the initial conizations, the patient was found to have invasive adenocarcinoma 1 year later. It is concluded, after review of the pathologic features of AIS, that if conservative management of AIS is elected, then standard cold knife conization should be performed and not LLETZ. Further study is required to establish the overall safety of conservative treatment of cervical AIS, including the use of LLETZ.

Adenocarcinoma↗
PubMed1977

Management of carcinoma in situ of the cervix.

Sixty-eight patients with in situ and seven patients with microinvasive cervical carcinoma were reviewed. Thirty per cent of the patients with carcinoma in situ were 30 years old and under. The mean age for carcinoma in situ was 37.8 years; for microinvasion, 42.6 years; and for postconization residual carcinoma, 48.5 years. Forty per cent of the patients were para 0 or 1. There was a 13 per cent incidence of postconization complications. The incidence of residual carcinoma in 58 patients who underwent conization and subsequent hysterectomy was only 10.3 per cent. The residual carcinoma was present high in the endocervical canal of the hysterectomy specimen. None of the patients with microinvasion had residual carcinoma. A positive correlation was found between the anatomic extent of the lesion on the conization specimen and the incidence of residual carcinoma. We conclude that conization and careful follow-up frequently are effective therapy for treating cervical carcinoma in situ, thereby reducing the incidence of hysterectomy.

Adolescent↗
PubMed1983

Prognostic factors in early invasive carcinoma of the uterine cervix. A clinical, histopathologic, and statistical analysis of 343 cases.

Three hundred forty-three cases of early invasive carcinoma of the uterine cervix were analyzed. Depth of infiltration and lateral extension of the tumors varied between 0.2 and 9.0 mm and 0.4 and 17.2 mm and were found to be of no prognostic importance. A multivariate statistical analysis revealed several risk factors: an epithelialized portio at diagnosis, suspected or evident tumor invasion in capillary-like spaces, absence of tumor-free margins at conization, and treatment with conization or simple hysterectomy, especially in the presence of the above-mentioned factors. Tumors of a large cell keratinizing type were prognostically favorable. Confluent growth was not associated with increased risk of recurrence or death from recurrence. Cervical biopsies proved to be inadequate as diagnostic material. Recurrences were almost always local and developed late. In absence of risk factors conization is sufficient treatment. In the presence of risk factors treatment should be the same as that performed for frankly invasive Stage IB carcinomas.

Carcinoma↗
PubMed1985

Management of stage IA carcinoma of the cervix.

One hundred fourteen patients with Stage IA carcinoma of the cervix were retrospectively reviewed in regard to depth of invasion, capillary-like space involvement, stromal reaction, status of conization margins, and the incidence of lymph node metastasis. Type of treatment, recurrences, and deaths were also evaluated. Patients with less than 3 mm invasion can be treated conservatively, including conization, if fertility is desired. No lymph node metastasis or recurrence appeared in this group of patients irrespective of type of treatment. Patients with 3 to 5 mm invasion do appear to be at higher risk for recurrence, but conservative therapy may be used in individualized situations. Size of conization and status of surgical margins appear to be important determining factors in regard to conservative therapy. Data in the literature, as well as our experience, although limited, suggest that the status of capillary-like space involvement does not influence lymph node metastasis or recurrence. Invasion of 5 mm or more in depth should be treated as a Stage IB occult lesion.

Carcinoma↗
PubMed1982

Cervical intra-epithelial neoplasia in pregnancy.

A retrospective analysis of 110 cases of suspected cervical intra-epithelial neoplasia (CIN) associated with pregnancy seen at the State University of New York at Buffalo (SUNYAB) affiliated hospitals is the subject of this report. One hundred anf five patients had abnormal cytology and five had negative pap smears. The majority of patients (60%) were in their twenties, and 24% were primigravidas. Colposcopic examination with or without directed biopsy eliminated the need for conization in 104 of 107 patients. Only two patients had to have cone biopsy and one had a modified conization after colposcopically directed biopsies. Varying degrees of cervical intra-epithelial neoplasia (Grades I-III) were diagnosed in 55 cases. One patient had therapeutic conization and two with a poor follow-up history had cesarean section hysterectomies. Post pregnancy regression of CIN was documented in 20 cases and persistence in 19 cases. The literature is surveyed and the management of CIN in pregnancy is discussed.

Adolescent↗
PubMed1995

Synthetic hygroscopic cervical dilator use in patients with unsatisfactory colposcopy.

OBJECTIVE: To assess the ability of a synthetic hygroscopic cervical dilator to make an unsatisfactory colposcopic examination satisfactory, thereby avoiding cervical conization. MATERIALS: From April 1991 to March 1993, 30 women with unsatisfactory colposcopic examinations underwent repeat colposcopy after a synthetic hygroscopic cervical dilator had been placed in the endocervical canal for approximately 2 hours. RESULTS: The reasons for initial unsatisfactory colposcopy in the 30 patients were squamocolumnar junction not seen in its entirety (18 patients, 60%), lesion not seen in its entirety (ten, 33%), and neither transformation zone nor lesion seen in their entirety (two, 7%). Complications were encountered in one patient from whom the dilator could not be removed completely. Of 29 patients undergoing repeat colposcopy, 23 (79%) had satisfactory examinations. In 15 of 30 patients, conization was avoided; it was required in six of 30 (20%) women for persistent unsatisfactory colposcopy (including the patient in whom the dilator broke) and in nine of 30 (30%) for other indications. CONCLUSIONS: This experience suggests that a synthetic hygroscopic cervical dilator can be used in patients with an unsatisfactory colposcopy to achieve a satisfactory examination, thus avoiding cervical conization.

Abortifacient Agents↗
PubMed2006

A new approach to preserve fertility by using a coated nitinol stent in a patient with recurrent cervical stenosis.

OBJECTIVE: The incidence of hematometra caused by cervical stenosis after conization is <1%. Nevertheless, if dilatation was unsuccessful, further therapy often remains unclear, and the clinical consequences can be severe, including hysterectomy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 33-year old patient who developed recurrent cervical stenosis with consecutive hematometra after two conizations during lactation amenorrhea that could not be treated by dilatation and insertion of a temporary plastic catheter according to the manufacturer's instructions. INTERVENTION(S): Insertion of a coated nitinol stent in the cervical canal after dilatation and hysteroscopic removal of the hematometra. MAIN OUTCOME MEASURE(S): Normal menstruation, future pregnancy. RESULT(S): The patient was free of symptoms, had a normal menstruation, and has become pregnant. CONCLUSION(S): The insertion of a coated vessel stent in the uterine cervix appears to be a valid alternative in patients with recurrent cervical stenosis and hematometra after conization to preserve childbearing function.

Adult↗
PubMed1980

The treatment of cervical intraepithelial neoplasia by cone biopsy.

Between 1968 and 1976, 175 patients with severe dysplasia or carcinoma in situ were treated at the University of California, San Francisco. One hundred fourteen underwent therapeutic conization while 61 were treated definitely by hysterectomy. Bleeding was the main complication of cone biopsy. It occurred in 9.9% of all conizations, but only 2% of patients required transfusion. Although follow-up has been relatively short, two patients treated by therapeutic conization, who were lost to follow-up, subsequently developed recurrent invasive cancer and four have developed recurrent carcinoma in situ or severe dysplasia. One patient treated by hysterectomy has developed metastatic cancer and one has had a recurrence of severe dysplasia at the vaginal vault. There have been 32 pregnancies following cone biopsy with no increase in abortion or prematurity.

Adult↗
PubMed1999

Predicting compliance with follow-up recommendations after colposcopy among indigent urban women.

OBJECTIVE: To determine correlates of compliance with follow-up recommendations after colposcopy. METHODS: Between October 1, 1992, and June 30, 1997, management recommendations were made to 451 consecutive women who attended a resident colposcopy clinic. Compliance was determined after 8-12 months. Correlates of compliance were assessed by univariate and multivariate analyses. RESULTS: Recommendations included repeat cytology in 6 months for 252 women, loop excision for 114, conization for 27, repeat colposcopy for 51, other for three, and not recorded for four. Rates of ever complying were 81% for loop excision, 85% for conization, 62% for repeat colposcopy, and 36% for repeat cytology. In multivariate analysis, the only significant predictors of compliance were history of genital herpes simplex infection (odds ratio [OR] 0.20; 95% confidence interval [CI] 0.05, 0.86, P = .03) and the nature of the recommendation (OR 4.73; CI 2.51, 8.92 for loop excision; OR 8.72; CI 2.57, 29.6 for conization; and OR 2.53; CI 1.30, 4.93 for repeat colposcopy, all against observation, P<.001). CONCLUSION: After colposcopy, women were more likely to comply with earlier, more intensive interventions, although the relative effect of follow-up interval and intervention could not be distinguished.

Adolescent↗
PubMed1995

Cervical cytology and conservative management of cervical neoplasias during pregnancy.

To elucidate the clinical significance of cervical cytology during pregnancy, 7,725 pregnant women were examined. Abnormal cytologic findings were recorded in 65 cases (0.8%). Colposcopically directed punch biopsies revealed cervical dysplasia and carcinoma in 27 cases (0.35%). The incidences in a massive examination for 714,119 women in Osaka Prefecture were 1.1% and 0.25%, respectively. Cytologic findings of the patients with cervical neoplasia during pregnancy agreed well (76%) with their histologic findings. Colposcopically, the squamo-columnar junction was visible in many cases, and white epithelium was most commonly observed during pregnancy. Pre- and postpartum follow-up study revealed that progression from dysplasia was seen only in two (20%) of 20 cases. Laser conization was performed on six women during pregnancy, and four were microinvasive carcinoma, all of which underwent normal vaginal delivery without any complication from conization. These results suggest that routine cervical cytology must be performed during pregnancy, and cytologic and colposcopic diagnosis may supply enough data to avoid unnecessary biopsies. Moreover, laser conization is recommended as an excellent diagnostic and therapeutic procedure for women with microinvasive carcinoma during pregnancy.

Adolescent↗
PubMed2003

Hysterectomy for Treatment of CIN.

The objective of this investigation was to determine the percentage of microinvasive and invasive cancers found when CIN 3 was treated by hysterectomy. The postoperative histologic findings of all patients with CIN 3 treated by conization or hysterectomy were analyzed. In 295 patients treated by conization, 14 (4.75%) microinvasive and 11 (3.73%) invasive cancers were found. Histologic analysis of 106 hysterectomy specimens revealed microinvasive carcinoma in 11 (10.38%) and invasive carcinoma in 17 (16.04%) cases. The finding of unexpected invasive cervical cancer in hysterectomy specimens seems significantly higher compared with conization. One must be cautious to avoid hysterectomy as the primary mode of treatment for women with coincident uterine pathology, postmenopausal women, or those who do not desire further reproduction. Hysterectomy as a mode of treatment for CIN 3 should be performed only if the existence of invasive cancer was excluded with certainty.

Journal Article↗
PubMed1985

The diagnosis, treatment and complications of cervical intraepithelial neoplasia--experience at the Royal Hospital for Women, Sydney, during the years 1972-1982.

During the 11 years 1972-1982, 770 patients with cervical intraepithelial neoplasia III (carcinoma in situ/severe dysplasia) were treated at The Royal Hospital for Women, Sydney. Of these, 592 had primary conization (Group I) and 153 had colposcopically directed biopsy and diathermy (Group II). Carcinoma in situ was diagnosed in the remaining 25 following hysterectomy for other gynaecological indications. The recurrence rates were similar in the 2 groups, but the conization group had a complication rate of 9.6% while none of the patients in group II had any significant complications. The presenting symptoms, gravidity, cytology and histopathological diagnosis were similar in the 2 groups. The conization and subsequent hysterectomy rates have decreased over the years. However, 50% of patients are still treated in this institution by cone biopsy. More conservative treatment (biopsy and diathermy) is being performed in increasing numbers of younger patients.

Adult↗
PubMed1978

Follow-up studies in dysplasia and cancer in situ of the cervix uteri.

In order to study when recurrences appear following conization for dysplasia or cancer in situ of the cervix uteri, a series of 477 patients has been investigated. They all underwent conization at Sabbatsberg 1965-1970. Among the 181 cases of dysplasia two developed recurrences one respectively three years after treatment. In the series of 296 patients with cancer in situ thirteen recurrences appeared. Eight of them were detected within the first three years. The other five were spread out during the next four years. About 50% of all patients had been followed-up for five years or more (Table I). The conclusion is reached that a yearly follow-up is necessary for at least ten years. As it is impossible to take care of such an accumulating number of examinations at the Swedish departments of obstetrics and gynecology without extra personnel, the following proposal is made. During the first three years after treatment the examinations are performed at the department where the conization has been performed. After that period the follow-up is limited to vaginal smears taken once every year in connection with the general gynecologic health control.

Adult↗