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[Premalignant and malignant lesions of the uterine cervix--personal experience].

INTRODUCTION: Cervical pathology represents the most frequent cause of mortality and morbidity in regard to female genital diseases in Serbia. The aim of this study was to establish the occurrence and grade of histopathologic lesions by examination of cervical biopsy specimens taking into consideration the patient's age and knife conization as a diagnostic-therapeutic procedure. The study included a period of 1993-1997 at the Department of Gynecology and Obstetrics of the Health Center in Sremska Mitrovica. MATERIAL AND METHODS: Criteria for biopsy were: colposcopic or naked eye evaluation of lesions and Papanicolaou smear grade III or higher. Conization was not performed in cases with: low grade squamous intra-epithelial lesion (L-SIL) with HPV (human papillomavirus) and high grade squamous intra-epithelial lesion (H-SIL) or microinvasive Ca (< 5 mm without distribution by lymph or blood). None of the patients had undergone biopsy before. RESULTS AND DISCUSSION: Our results show high occurrence of malignancy, mainly of invasive type. In elder patients all grades of pathologic lesions were established, whereas knife conization showed high efficacy. Although patients might be exposed to risk factors predominantly in their older age, it is evident that public knowledge is poor, while physician-patient relationship is unsatisfactory. CONCLUSION: In accordance with reported, it can be concluded that there is a great need for public health education as well as improvement of secondary health care in the long run.

Adult↗
PubMed1975

[Therapeutic results of colposcopically controled collection of cervix tissue in atypical smears of women up to the age of 35 years].

The case series consists of 106 women consecutively collected during 1968 to 1973 from those with a vaginal smear belonging to Papanicolou's groups III and attending the gynaecological department in Umeå. Probably the series is a fair random sample of the population (congruent to 150,000 people) of the area served by the clinic. The extension of the colposcopically delimited atypical transformation zone (with its upper bordèrline against normal cervical villi) in most cases being small, the surgical procedure--a small cone congruet to ring biopsy--was accordingly insignificant. In 9 cases only a large conization was performed. As only a small part of the cervical tissue was usually removed it is probable that the enzymatic and mechanical properties of the cervix as well as its capacity as a sperm reservoir could be preserved. The median of the observation time is 26 months, range 3 months to 5 years. At the follow up the colposcopic and histological picture has so far shown no sign of atypia in 91 subjects. The same applies cytologically to the patients subjected to a large conization. Two women have moved away from the district. A relapse occurred in 4 patients, who after a large conization have remained cytologically negative. Throughout the investigation the term a typia has been used to characterize the cytological, colposcopic and histological changes, the degree and extension of this atypia being taken into considertion. Thus the abstruse nomenclature in common use is avoided. Cytological atypia is cellular in character, while histologically it includes the degree of structural derangement of the epithelial architecture as well. Colposcopically the angioarchitecture and the capillary distance seem to be the most important features. The correlation between the colposcopic and the cytological and histological findings is high when the degree of atypia is marked. It is inferred, therefore, that the descriptive term atypia should replace the superfluos bulk of terms in the fields in question.

Colposcopy↗
PubMed1976

The making of a colposcopist. A safe and sensible approach.

A program was established to determine the accuracy of colposcopy at our institution. Forty-three patients with cytologic or histologic evidence of severe dysplasia or worse underwent diagnostic conization following satisfactory colposcopy. Thirty patients subsequently had either therapeutic conization or hysterectomy preceded by biopsy only. In all 73 cases, the surgical specimen did not reveal a more advanced lesion. However, when the colposcopy was unsatisfactory, the rate of error was 20.8%. It is our opinion that colposcopy is a safe and valuable technique as long as one recognizes the need for training and understands the indications for further diagnostic studies. The use of the colposcope for the evaluation of abnormal cervical cytology has increased steadily over the last few years, and several excellent courses are now offered throughout the United States. Armed with a certificate from such a course, many gynecologists then become self-proclaimed colposcopists in spite of warnings to the contrary by the instructors. In addition, supervision by experienced personnel is not always available. How, then, does one indeed become an accomplished colposcopist to the point that he or she can safely spare the patient the risk, inconvenience and expense of diagnostic cervical conization? Although several recent publications 2,5,6,9,11 document the diagnostic accuracy of colposcopically directly biopsies, we feel each individual should develop and evaluate his or her own skill before altering or abandoning conventional methods of diagnosis and management. The purpose of this report is to present our experience with colposcopy utilizing a program which can perhaps serve as a model to other clinicians.

Biopsy↗
PubMed2003

[Human papillomavirus infection and cervical intraepithelial neoplasia].

OBJECTIVE: To determine the presence of high-risk, oncogenic types of HPV infection (HR HPV) and the presence of HPV 16 and 18 in various degrees of cervical and intraepithelial neoplasia. TYPE OF THE STUDY: A retrospective study. NAME AND ADDRESS OF THE INSTITUTION: Obstetrical-Gynecological Clinic, Faculty Hospital, Ostrava. METHODS: The study included 205 female patients indicated for conization due to cervical intraepithelial neoplasia. The conization was preceded by extended colposcopy, cytological samplings, HPV DNA test and a directed biopsy. HR HPV was examined in all patients, HPV 18 and 16, respectively, in 98 (48%) patients. Based on severity of histopathological findings the patients were divided into three groups, examined for positivity of oncogenic HPV types and the high risk HPV 18 and HPV 18 types, respectively. RESULTS: The histopathological findings from a total number of 205 conuses included five (2%) benign lesions, 85 (41%) CIN1, 77 (38%) CIN 2 and 38 (19%) CIN 3. Altogether the HR HPV was demonstrated in 143 (70%) patients. In patients with the benign lesion no HPV infection was detected. In patients with the CIN 1 finding the HR HPV infection was detected in 35 (41%) cases, in patients with CIN 2 in 70 (91%) cases and in patients with CIN 3 in 38 (100%) cases. HPV 16 was diagnosed in patients with the CIN 1 finding in 9 (23%) cases, HPV 16 in 5 (6%) cases and both types of the virus were present in two (2%) cases. In CIN 2, HPV 16 was positive in 17 (43%) and HPV 18 in 6 (8%) cases. In patients with CIN 3, HPV 18 was detected in 9 (53%) and HPV 18 in 2 (5%) patients. In all the women who underwent conization, HPV 16 infection was demonstrated in 17% and HPV 18 in 6% patients. In 19% of patients, the infection by at least one type of the virus was present and in two % both types of the virus were present. CONCLUSION: The presence of HR HPV rises with increasing severity of cervical intraepithelial neoplasia, HR HPV being detected in all cases suffering from CIN 3. The highest risk type HPV 16 was present with increasing rate in relation to the severity of cervical intraepithelial neoplasia, whereas no such trend was present in case of HPV 18.

Adult↗
PubMed2004

[Stage IA1 squamous cell carcinoma of the uterine cervix: a report of 30 cases].

BACKGROUND & OBJECTIVE: The preoperative diagnosis and management of stage IA(1) squamous carcinoma of the cervix remains a controversial subject. The aim of this study was to discuss diagnosis and appropriate management options of this disease. METHODS: Clinical data and pathological materials of 30 patients with stage IA(1) squamous carcinoma of the cervix, who were treated in Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College between 1992 to 2001, were reviewed. RESULTS: Seven of 30 patients (23.3%) had neither specific symptoms nor signs. Twenty-three patients had cytological examination with the positive rate of 86.9% (20/23). Colposcopy was performed in 23 of the women; the accuracy of colposcopical impression was 78.2%(18/23). Of 10 endocervical curettage (ECC) specimens, 4 cases had abnormal pathology. Among 30 patients, 22 (73.3%) were treated with radical hysterectomy, 6 with simple hysterectomy, and 2 with cold conization only. There was no parametrical involvement and no positive vaginal margin in any of 28 patients who had hysterectomy. Lymphadenectomy was performed in 8 cases; the mean number of lymph nodes removed was 22, and no metastasis was found. The two conization specimens had free surgical margin. The preoperative diagnosis agreed with final diagnosis in only 56.7% (17/30); there was statistically significant difference between them (P< 0.01). During median 34 months follow-up (range, 17-111 months), no developed recurrences and no died from cancer. CONCLUSION: The diagnostic accuracy of colposcopically directed biopsy is quite poor for stage IA(1) cervical carcinoma. Cervical cold conization may increase the diagnostic accuracy and may be recommended for patients who desire conservation of fertility.

Adult↗
PubMed2004

[Reliability of screening methods in the diagnosis of dysplasia and cervical carcinoma in asymptomatic women].

UNLABELLED: The aim of this study was to estimate the reliability and accuracy of the chosen methods: cytological results (PAP smear) and colposcopic findings in the detection of cervical dysplasia and cervical cancer. MATERIAL AND METHODS: We have analyzed post conization pathohistological results and compared them with cytology results and colposcopic findings in 51 patients. Surgical procedure (conization) was performed for diagnostic and therapeutic reasons. RESULTS: Results have shown that there is a positive correlation between cytological and colposcopic results on one side and post conization pathohistological results, on the other side (p < 0.02). CONCLUSION: According to our experience, both screening methods (cytology and colposcopy) are reliable methods if performed by properly educated staff, and they both influence (reduce) morbidity and mortality among women.

Adult↗
PubMed1992

[Laser treatment of premalignant diseases of the uterine cervix. Experiences from a central hospital].

During the six-year period 1984-89, 387 patients with cervical intraepithelial neoplasia were treated with CO2-laser. The procedures were performed under local anesthesia in the outpatient clinic. 342 patients underwent conization, 45 vaporization. Complications occurred in 28 patients treated with conization; the most common being postoperative bleeding, seen in 12 cases. In 75% of the cases there was good correlation between histologic examination of the cone biopsy and cervical biopsy/curettage. In 41 patients (12%) the resection borders were involved or indeterminate. Persistence or recurrence was observed in two patients treated by vaporization and 11 treated by conization. Recurrence was diagnosed after 9-65 months of follow-up.

Adolescent↗
PubMed1991

Laser surgery for cervical intraepithelial neoplasia.

The laser has provided a relatively easy and safe method for treating all types of CIN. The advantages of lasers include great conservatism due to tissue sparing, great precision because of microsurgical method, combination of excisions and vaporization possible, suitable for therapy of multifocal disease, uncluttered field, and good hemostasis. Although other modalities have also been used successfully in the therapy of this disease, it appears that none are so versatile as CO2 laser or possess its ability to accurately treat the multifocal disease that may involve large surface areas of the lower reproductive tract. It seems unlikely that any of the cervical ablation methods--chemical destruction, hot cautery, diathermy electrode, cryoprobe, laser, and diathermy loop--will completely disappear from use in the near future. Ablation is an attractive alternative to cold-knife excision in properly triaged patients, since it is almost always an outpatient procedure done without anesthesia or with only local anesthesia. Most importantly, a large number of patients have completely visible lesions of a severity less than that of in situ cancer; they really do not need excisional conization by any technique and benefit by quick ablation of the transformation zone. A conization, to be diagnostic and therapeutic, must remove the entire transformation zone to the proper depth. This procedure is almost always attended by a higher morbidity rate than is simple ablation. Laser excisional conization and the large loop excision of the transformation zone procedure are similar in a number of respects, because the operator must have certain capabilities and a through understanding of the disease to be treated to perform the operation correctly.

Carcinoma in Situ↗
PubMed1991

Management of cervical intraepithelial neoplasia where colposcopy is not available.

A study was carried out to determine the effectiveness of the various methods used for treating patients with cervical intraepithelial neoplasia (CIN) detected by the cervicovaginal smear screening programme at the University College Hospital, Ibadan, Nigeria, over a period of five years. During the period, 3 004 patients were screened, of whom 292 (9.7 pc) had smears suggestive of CIN. There were no facilities for colposcopic evaluation of the patients. The patients were treated by cryotherapy, electrocautery, conization of the cervix and hysterectomy. Persistence rates of CIN after cryotherapy and electrocautery were 30.3pc and 31.2pc respectively. There was no evidence of persistent CIN in patients treated with conization or hysterectomy. It is suggested that in the absence of colposcopic guidance, conization or hysterectomy should be used to treat CIN rather than blind application of locally destructive methods like cryotherapy and electrocautery, particularly the higher grades of CIN.

Adult↗
PubMed1990

Clinical diagnosis in microinvasive carcinoma of the uterine cervix.

This retrospective study collected the surgical tissues and the clinical records of 197 surgically treated patients with microinvasive carcinoma of the cervix, which was defined as a limited microinvasion not more than 3 mm in depth regardless of lymph-vascular involvement. Depth of invasion was 1 mm or less in 13.2% and 1.1 to 3 mm in 86.8%. The mean age was 47.2 years. About half of the patients were asymptomatic but suspected cytologically. Random cervical biopsy alone was inadequate for diagnosis. Cone biopsy demonstrated an accuracy of 94% in diagnosis, but failed to eliminate microinvasive carcinoma in 23.0% of the hysterectomy specimens. In 14 cases, the invasion was more extensive in the uterus than in the cone. A positive correlation has been found between the diagnostic rate of conization and the depth of stromal invasion. Cervical conization, while relatively accurate in assessing the existence of stromal invasion that characterizes microinvasion, failed to diagnose those with deeper stromal invasion, especially beyond 1 mm. The recommended approach in diagnosing microinvasion is careful colposcope-directed cone biopsy and proper examination of the conization specimen in order to exclude the possibility of more advanced disease.

Adult↗
PubMed1989

[Cervical intra-epithelial neoplasia].

The recommendations of proceeding in cases with CIN have significantly changed within the last years due to various reasons: Research on the biological development of CIN resulted in new concepts; as the age of patients showing-up with CIN decreased considerably, the need of more conservative diagnostic an therapeutic procedures became evident; it also was proved that human papilloma viruses contribute strongly to the etiology of CIN. So, objections against conization as the classical method of diagnosis and surgical treatment of CIN were increasingly substantiated. In order to find less invasive methods than conization, some alternatives were examined, and the combination of differential cytology, differential colposcopy and directed biopsy has proved in the meanwhile to be a valuable diagnostic alternative choice, not bearing the harmful implications of diagnostic conization. For therapy new methods have been elaborated as well, so electrocoagulation (= cauterization), cryosurgery and CO2-laser evaporization. All these methods allow a satisfactory treatment in most cases. We are recommending strongly to individualize and differentiate the procedures of diagnosis and treatment in CIN. Destructive surgery can be abandoned without taking the risk of inaccurate diagnosis or incomplete treatment.

Adult↗
PubMed1988

Colposcopic management of abnormal cervical cytology in pregnancy.

Two hundred sixty-five pregnant women with abnormal Papanicolaou smears underwent colposcopy; 248 of them underwent directed cervical biopsies. Correlation of cytology with histology indicated concordancy within one grade in 202 of 241 patients (84%). Cytology was significantly more advanced than directed cervical biopsy in 15% and significantly less advanced in 1%. None of the 163 patients with moderate dysplastic cytology or less had microinvasive or invasive disease. Cervical conization was performed on 23 women, 4 of whom underwent modified radical hysterectomy for microinvasive carcinoma. Sixteen of 18 patients undergoing conization in pregnancy were available for postpartum follow-up and had persistent cervical dysplasia. Of 242 women followed conservatively, without pregnancy conization, 88 underwent postpartum evaluation. There were no false negatives in the antepartum evaluation of malignancy.

Adolescent↗
PubMed1986

Reliability of the frozen section in sharp knife cone biopsy of the cervix.

Eight patient records were reviewed following cold knife conization in which frozen section diagnosis was utilized to aid the surgeon in formulating appropriate therapy after conization. Two patients were diagnosed as having microinvasive squamous cell carcinoma on final pathology when frozen sections were read as showing no invasion. Furthermore, in the 51 instances in which a degree of cervical dysplasia was determined from frozen sections, 14 discrepancies were noted on final pathology (27%). Such discrepancies may lead to unnecessary hysterectomies performed for cervical dysplasia that is easily treated with outpatient office procedures, especially when cold knife conization and frozen section diagnosis are performed without prior colposcopy and biopsy.

Adult↗
PubMed1986

[Follow-up studies after incomplete excision of cervical carcinoma in situ].

To understand the biological nature and the treatment of cervical carcinoma in situ (CIS), numerous (216) incompletely excised specimens obtained by conization at Auckland University's National Women's Hospital were examined and the histological findings with long-term follow-up were correlated. Follow-up studies were possible in 211 patients for two years or more; 88.4% were followed up for at least five years. There was no evidence of recurrence in 62.9% of the total series. Recurrences were related to the area of CIS in the cervix, and the incompletely excised sites and blocks. Micro-invasive carcinoma was found in four patients (1.90%) and invasive carcinoma (stage Ib "occ") in two (0.95%). The following conclusion has been drawn: If CIS is incompletely excised by conization, follow-up examinations are essential. When the CIS is small in the cervix or it is incompletely excised only outside the endocervix, spontaneous disappearance can be expected. In the entire series, including patients in whom the incomplete excision left a fairly large CIS remnant, the nonrecurrence rate was unexpectedly high. These findings suggest that the continued existence of incompletely excised CIS is significantly inhibited by a considerable damage to the conization.

Carcinoma in Situ↗
PubMed1985

[Studies on the management of CIN accompanied by infertility].

We performed cytological examinations on 863 of the 969 patients (89.3%). In the final diagnosis, 4 patients had carcinoma in situ (0.5%) and 1 patient had microinvasive carcinoma (0.1%). Therefore, it is important to perform cytological examinations on infertility out-patient s, and conduct routine cytological examinations when infertility treatment is being continued over long periods. The detection rate for the 18 patients who required detailed examination did not differ between primary and secondary infertility, or with the period of infertility or the factor causing infertility. The follow up after conization should be done carefully, and the patient should be encouraged to become pregnant as early as possible. Unlike fertile women, in infertile women, conization should be performed, even in the case of carcinoma in situ, provided: There is a specialist well-experienced in cytology, colposcopy, and histology; the patient and family are fully satisfied with the physician's explanation; the physician can maintain good contact with the patient and family and continue to provide adequate follow up treatment, and the lesion is in the ectocervix, and the whole lesion can be removed by conization without leaving intact foci.

Adult↗
PubMed1985

[Treatment of neoplasms of the uterine cervix by CO2 laser].

CO2 evaporation was undertaken on 241 patients with cervical intraepithelial neoplasia. The results obtained six weeks after the treatment revealed disappearance of 89.6% of the lesions, and the therapeutic results obtained one year after reirradiation were favorable; 97.5% of the lesions had disappeared. However, not a few patients have some neoplasms of the uterine cervix to which this therapy is not applicable. Therefore, conization was started for treatment combined with diagnosis by means of CO2 laser. The therapeutic effect has been studied in 64 patients to date. Five patients with carcinoma of stage Ia and four patients with endoepithelial carcinoma who had undergone hysterectomy after conization were examined for the presence or absence of residual lesions. The lesions had disappeared completely. The remaining 64 patients who had not undergone hysterectomy are now under follow-up study, and a residual lesion was observed in only one patient, suggesting the possibility of treating a large number of CIN patients by evaporation combined with conization.

Adult↗
PubMed1979

Management of abnormal Papanicolaou smears in pregnancy.

All pregnant patients with abnormal cervical cytologic smears were evaluated as outpatients in the colposcopy clinic. Of the 131 patients, 84% had colposcopically directed biosies. Initial biopsy diagnosis of severe dysplasia/carcinoma in situ was noted in 16% of patients with class II smears and 43% of patients with class III smears. Two patients underwent conization and 2 had modified conizations because they failed to meet our criteria for adequate colposcopic evaluation. Of the 110 patients available for postpartum follow-up, all had either the same or a lesser degree of cervical intraepithelial neoplasia. Invasive carcinoma was not detected in any patient who underwent subsequent hysterectomy or conization. No abortions or premature labors could be directly attributed to the procedure.

Biopsy↗
PubMed1968

Carcinoma in situ of the uterine cervix. A review of some present clinical problems.

The vaginal smear reveals a spectrum of borderline lesions of the uterine cervix. This spectrum is the source of new clinical problems involving both the recognition and treatment of these various entities. A review of the literature of the past decade indicates that vaginal smears should be obtained regularly every year or two in all women beginning at the onset of sexual activity, but the initial smear may be falsely negative in 10 to 30 percent of cases. When patients have abnormal smears, the precise diagnosis can be established more accurately by cold-knife conization than by multiple punch biopsy. While hysterectomy has been considered "definitive treatment," late recurrence in the vagina occurs in 1.24 percent of patients so treated. A compilation of 1,100 patients with carcinoma in situ of the cervix treated by conization and follow-up smear reveals that in over 90 percent the disease was controlled by the cone alone, and the remainder by repeat cone or hysterectomy. Precise definition is required in treatment decisions concerning micro-invasive lesions, but these may be well treated by non-radical measures. In almost 500 patients so treated, no death occurred from therapy or tumor metastasis.When carcinoma in situ is found during pregnancy, a coexisting invasive carcinoma must be excluded by appropriate conization or punch biopsy and definitive therapy completed after vaginal delivery.

Carcinoma↗