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PubMed1970

[Histological diagnosis of precancerous and early stages in cancer of the cervix uteri].

The histologic diagnosis of premalignant and early malignant lesions of the cervix uteri necessitates the teamwork of histologists and clinicians. This cooperation amounts to: 1. the indication for biopsy; 2. the technic of biopsy; 3. the histologic technic; 4. the agreement of nomenclature of pathologic epithelium with identical prognostic evaluation of the different lesions. The indication for biopsy is confirmed by the result of cytology and colposcopy. In every single case seeming suspicious either by cytology or colposcopy a biopsy must be done. Great numbers of biopsies require a method which can be performed at an outpatient department, such as Schiller's scraping, punch biopsy and curettage of the cervical channel. The positive diagnosis originating from such a small biopsy specimen only justifies the necessity of treatment, not however the method of therapy. The extent of treatment is determined by the histologic diagnosis of cone biopsy which has to be done next. At what extent, depends on the visibility of the whole lesion and especially on the visibility of the maximum of possible existent invasion. Good technic of conization and step serial sections satisfy this condition. If handled as said reduced cancer therapy is admissible: in cases of carcinoma in situ or of severe dysplasia by conization or by total hysterectomy; in cases of early stromal invasion by hysterectomy or even by conization. Whether or not a reduced cancer therapy was permissible, also in cases of microcarcinoma, is to be decided by follow up controls of cases treated by these methods. Here too the condition is the exact determination of the whole lesion by step serial sections of the cone.

Biopsy↗
PubMed1983

The "unsatisfactory" colposcopic examination.

One hundred nine of 735 patients (14.8%) referred for colposcopic evaluation had "unsatisfactory" examinations. Of 108 women 40 years of age or over, 81 had unsatisfactory examinations (45%) as compared with 28 of 555 women under 40 (5%) (p less than 0.001). Thirty-five of the 109 patients with unsatisfactory examinations (32%) had had prior cautery or conization as compared with 141 of 626 in the "satisfactory" group (22.5%) (p less than 0.04). Seventy-three of the 99 patients on whom follow-up information was obtained had cervical conization biopsies for final diagnoses. Correlation with previously performed endocervical curettage and colposcopically directed biopsies was poor. Careful correlation of cytology, colposcopy and histopathology is necessary to achieve optimal results in the management of patients with unsatisfactory examinations. Diagnostic conization continues to play an important role in the management of patients with abnormal cervical cytology.

Adult↗
PubMed1982

Cone biopsy during pregnancy.

Under a diagnostic schema that used cervical conization liberally for evaluating women with abnormal Papanicolaou smears, 82 pregnant patients underwent conization. Fifteen had significant morbidity related to cervical bleeding. The uncorrected perinatal mortality was 44.1/1000. Sixty-one cone biopsies, performed before colposcopy was introduced into the schema, uncovered 2 cases of previously undiagnosed invasive carcinoma. Among 21 patients who underwent colposcopy before conization, 1 case of microinvasive carcinoma was diagnosed. During the study, 15 patients with frankly invasive carcinoma were identified, 9 by punch biopsy of a gross lesion, 2 by cone biopsy without prior colposcopy, and 4 by colposcopically directed punch biopsy. As a result of the review, the diagnostic schema has been changed so that biopsy is used less often on pregnancy patients.

Biopsy↗
PubMed1982

Treatment and follow-up study of squamous cell carcinoma in situ of the cervix uteri.

The survey of approved cancer programs done by the Commission on Cancer of the American College of Surgeons observed a total of 9,468 patients with a diagnosis of in situ squamous cell carcinoma of the cervix uteri. Sixty-four per cent of these patients had been observed for at least nine years. The most commonly used definitive treatment was hysterectomy. Recurrences were observed after hysterectomy, conization and radiation therapy. There were significantly more recurrences in the group treated by conization compared with those treated by hysterectomy. The highest rate of second cancer primary to the vagina, vulva, uterus or ovaries was among patients who received no treatment. The cancer specific, ten year survival rate for those with no treatment was 96.6 per cent, and for those treated by conization or by hysterectomy, the rates were 99.3 and 99.8 per cent, respectively.

Adult↗
PubMed1980

Treatment of carcinoma in situ: evaluation of 1609 cases.

In 1609 cases of carcinoma in situ, various methods of treatment were adopted: primary irradiation (22 cases), radical hysterectomy (11), simple hysterectomy (418), cervical amputation (83), ring biopsy with cervical curettage (63), and conization alone (1012). The outcome was related far less to the method of treatment than to the reliability of the primary diagnosis. If the latter was based only on colposcopically directed punch biopsies or cervical curettage, even with ring biopsy, 2.1% of patients died of cancer. In patients treated by hysterectomy, the vaginal approach resulted in 4 times fewer recurrences than did the abdominal approach, because of visualization of the extent of the lesions. Best results were obtained after conization with serial step-sectioning of specimens. Among 634 cases treated by conization with total removal of the lesion, there were no recurrences.

Biopsy↗
PubMed1993

Studies on 200 cases of early squamous cell carcinoma of the cervix.

Two hundred cases of early squamous cell carcinoma of the cervix were studied, 109 with early stromal invasion (ESI) (FIGO stage Ia1) and 91 microcarcinomas (MCs) (stage Ia2). Nine percent of invasive foci arose from original (native) squamous epithelium, outside the transformation zone. What may have been "skip lesions" (see text) were seen in only two instances. Of the cases of ESI, 78% invaded to < or = 0.5 mm. Of the MCs, 65% invaded to < or = 3 mm, and > 50% measured < or = 50 mm3 in volume. Capillary-like space involvement (CLSI) was suspected in 32 cases (29%) of MC on hematoxylin and eosin (H&E) staining but could not be confirmed by Ulex europeaus agglutinin I lectin immunoperoxidase staining in 10. Forty-four MCs displayed a spray-like growth pattern, 34 a confluent pattern, and 12 both; one had a condylomatous appearance. Forty-eight MCs were grade 3, 27 were grade 2, and 16 were grade 1 in differentiation. Stromal response was assessed as absent in nine cases, weak in 53, moderate in 58, and intense in 80. The extent of associated cervical intraepithelial neoplasia (CIN) was widespread in all but nine cases. There were seven recurrences, including one definite and one possible tumor-related death. A single case of residual disease was observed. The new FIGO classification of preclinical stage Ia carcinoma as that diagnosed only by microscopy is sound. The division into stages Ia1 and Ia2 is reproducible and may be used for comparison between various institutions; the notion, however, that the length of MC should form part of its definition is not supported by these data. None of the variables (depth of invasion, length, area, volume, growth pattern, grade, stromal response, and CLSI) had any bearing on prognosis. Although stromal invasion can certainly be seen in small punch biopsies, a definitive diagnosis can be made only in conization (or hysterectomy) specimens. It is absolutely essential that conization specimens be thoroughly sampled, not only to make the correct diagnosis but also to be certain about the margins. Early stromal invasion behaves in the same manner as CIN and may be treated by conization alone provided the cone has been adequately sampled and the margins are free. Much the same applied to MC, although there were not enough patients whose tumors were associated with CLSI to be absolutely certain of the prognostic significance of the latter.

Biopsy↗
PubMed1994

Cervical cone margins as a predictor for residual dysplasia in post-cone hysterectomy specimens.

OBJECTIVE: To determine the relation between dysplasia at cervical cone margins and the presence or absence of residual dysplasia in post-cone hysterectomy specimens. METHODS: We performed a 6-year retrospective, multicenter study and reviewed 250 cases in which the patient had a cold-knife cervical cone biopsy followed by a hysterectomy within 6 months. Pathology reports from 23 institutions described the margins in conization specimens and the subsequent status of residual dysplasia in the hysterectomy specimens. RESULTS: There was a statistically significant difference in the prevalence of residual dysplasia in hysterectomy specimens between patients with positive margins on cone biopsy (47%) and those with negative margins (23%) (P < .01). The positive predictive value for residual dysplasia given positive cone margins was 47%, and the negative predictive value was 77%. The grade of post-cone residual dysplasia increased commensurately with the grade of dysplasia in the conization specimen. CONCLUSIONS: The presence of dysplasia at the cervical cone margin relates significantly with the presence of residual dysplasia in the post-cone hysterectomy specimen. The grade of residual dysplasia in the post-cone hysterectomy specimen increased as the grade of dysplasia in the conization specimen increased. Free margins on a cone biopsy specimen with dysplasia offer reassurance that invasive cancer is not present in the remaining uterus.

Analysis of Variance↗
PubMed1993

The value of endocervical curettage at time of cervical cone biopsy.

Two hundred eighty-nine patients were evaluated over a 23-month period to assess the efficacy of postcone biopsy endocervical curettage at the time of cervical conization. One hundred eleven patients were excluded because the endocervical curettage was insufficient or not performed, the final pathology on the cone biopsy and endocervical curettage revealed no dysplasia or cancerous process, or the endocervical margins were not assessed, leaving a total of 178 patients in the study population. A negative conization endocervical margin virtually assures no disease in the upper endocervical canal. The negative predictive value in this study population was 97%. We conclude that routine endocervical curettage is unnecessary for most patients and should be primarily considered for patients who are postmenopausal or for those receiving suboptimal conizations.

Adolescent↗
PubMed1977

[The optimal treatment of carcinoma in situ of the uterine cervix (author's transl)].

The results of treatment of carcinoma in situ of the uterine cervix in 380 patients seen between January 1, 1966 and December 31, 1973 are reported. There were 134 women age 40 or less. There were 246 patients age 40 or older. In 334 patients a total hysterectomy with removal of a vaginal cuff was carried out (87.9%). A large therapeutic cone biopsy was done in 46 patients (12.1%). In the 334 patients treated by hysterectomy, 2 recurrent carcinomas in situ of the vaginal vault were observed (0.6%). In 16 of the cases treated by conization later suspicious colposcopic and/or cytologic findings made hysterectomy necessary. In 5 of these cases a recurrent carcinoma in situ was likely. The postoperative morbidity after total hysterectomy was low. There was no postoperative death. The total vaginal hysterectomy with removal of a vaginal cuff is recommended as treatment for carcinoma in situ of the uterine cervix in order to avoid the diagnostic difficulties in the follow-up after treatment by conization and because of the low recurrence rate after hysterectomy. Conservative treatment should only be employed in patients who desire later child bearing. tthe psychological stresses of the continually required follow-up examinations after conization should not be underestimated.

Adult↗
PubMed1977

[On the optimal clarification of suspicous findings on the cervix uteri (author's transl)].

In the period 1972--1975 432 conizations were performed. 76,6% of all patients were dismissed healed after conization without necessity of hysterectomy; the duration of stay in hospital after operation was in uncomplicated cases 7,9 days, in complicated cases 9,9 days. In 13,9% complications were registered, mainly bleedings (10,9%). In more than half of the cases with not totaly removed carcinoma in situ the uterus showed rests of the malignant lesion. That indicates that in such situations a hysterectomy should be done in every case. If there was a suspicion of invasive carcinoma an excochleation was performed instead of cone biopsy. The high rate of false negative results in such cases confirms that the conization at the moment seems to be the method of choice in clarification of positive cytologic or colposcopic findings.

Adolescent↗
PubMedDate not supplied

[Cervical intraepithelial neoplasia and genital condylomatosis in HIV-positive patients. Clinical aspects and management].

In this study prevalence of cervical intraepithelial neoplasia (CIN) and genital condylomatosis in HIV-positive women and the possible relation between HIV and HPV infection and CIN have been analyzed. 66 seropositive women underwent cytological, colposcopic and, when necessary, histologic examination and the results have been compared with those obtained from 150 HIV-seronegative controls. HIV-positive patients were divided in two groups, depending on number of CD4+/mm3, < 400 or > = 400, to evaluate the relation between immunity and HPV infection and/or CIN. 35 seropositive and 136 seronegative patients affected by genital condylomatosis and/or CIN I were submitted to laser CO2 vaporization and the results of the treatment have been compared. All cases of CIN II and III underwent laser CO2 conization. Among HIV-seropositive patients the prevalence of genital condylomatosis appeared to be 87.9% and among the seronegative controls 18% (p < 0.001). Multilocated condylomatosis represented 58.7% of genital condylomatosis among seropositive women and 11.1% among the seronegative patients. In HIV-seropositive group the prevalence of genital condylomatosis was of 95.2% among women with CD4+ < 400 and of 75% among those with CD4+ > = 400 (p > 0.01). 13 patients (19.7%) of the 66 seropositive women and 12 of the 150 (8%) seronegative had a cervical intraepithelial neoplasia. A CIN III was diagnosed in 9 seropositive patients (13.6%) and in 5 seronegative (3.3%). Among the HIV-seropositive women who underwent laser vaporization for genital condylomatosis a cure-rate of 34.5% was found; among seronegative women who underwent the same treatment the cure-rate was of 79.4%. Those patients who underwent laser conization resulted all cured at first check. In the group of HIV-seropositive women a higher prevalence (p < 0.001) of genital condylomatosis, particularly multilocated localization, has been found than in HIV-seronegative patients. An increased prevalence of CIN has also been found among HIV-seropositive women. Genital condylomatosis in seropositive patients resulted extremely difficult to treat with laser vaporization in contrast with the 100% success in laser conization for high-grade CIN.

Adolescent↗
PubMed1976

[Adequate treatment of micro-invasive carcinoma of the uterine cervix (author's transl)].

At the University Department in Heidelberg 58 micro-invasive carcinomas of the uterine cervix were found between 1965 and 1974. 8 cases were diagnosed in other institutions by directed biopsies. Three cases were detected during the microscopic examination of uteri removed for emergency indications and three cases were detected after hysterectomy for cytological findings indicative of carcinoma in situ of the uterine cervix. In 44 cases an optimal conization of the cervix was carried out. Microscopic examination of these cases showed early stromal invasion in 33 cases. In 6 cases a newtork infiltration was found und in 5 cases a plump infiltration was found. The incidence of radical Wertheim operations of 21 in this group is explained by cases in this group who had inadequate diagnosis prior to admission. In 8 cases the indication for the Wertheim radical hysterectomy was a carcinomatous lymphangiosis in the conization specimen. In none of these cases metastatic tumor was found in the lymph nodes although 13 to 44 lymph nodes were examined per case. In accordance with the newer literature it is recommended to limit treatment of micro-invasive changes of the uterine cervix to routine hysterectomy or to optimal conization of the cervix if certain prerequisites are met. The results of the follow-up examinations of the reported cases appear to justify this recommendation.

Adult↗
PubMed2006

HPV DNA patterns and disease implications in the follow-up of patients treated for HPV16 high-grade carcinoma in situ.

Twenty-five patients with high-grade cervical lesions associated with HPV16 infection were studied at the time of surgical treatment and followed up after conization. Before surgical treatment, the following parameters were analyzed: (1) physical status of HPV16 DNA, (2) viral load, (3) cytological presentation confirmed by histological diagnosis, and (4) colposcopy. At the time of conization, (5) margin presentation, and (6) cone biopsy were evaluated. At each stage of the follow-up (7) physical status of HPV16 DNA, (8) viral load, (9) cytological test, and (10) colposcopy were repeated. The correlation between the different parameters was examined. Significant differences in the viral loads were observed between integrated and episomal forms and between the coexisting integrated/episomal forms and the only episomal form, while no statistically significant differences were observed between integrated and coexisting forms. At the first stage of follow-up, 11 of 25 patients analyzed (44%) were negative to HPV DNA cytology and colposcopy tests, 13 of the 25 (52%) were HPV16 DNA negative, 17 (68%) cytology negative, and 20 (80%) colposcopy negative. At the closing stage, 15 of 25 subjects (60%) were negative to all three tests, 16 of the 25 (64%) were HPV16 DNA negative, 19 (76%) cytology negative, and 20 colposcopy negative (80%). These observations suggest that in surgery treated patients the viral clearance at the closing stage of follow-up was unrelated to the HPV DNA physical status and to the viral load before treatment, but was associated significantly with the effectiveness of surgery treatment, in particular with margin cone presentation.

Adult↗
PubMed2005

A study of abnormal cervical cytology in pregnant women.

During the 4 year routine study of smears in 2,919 pregnant women, 33 cases of abnormals of the uterine cervix were detected (1.13%). The patients were followed with uterine cervical cytology and colposcopy and in case of need, sometimes punch biopsies were performed. The results of the cytologies, 33 cases with abnormalities were detected. There were 26 cases classified as class IIIa, 7 cases were class IIIb. All the cases underwent colposcopy. For the 17 cases that showed lesions by colposcopy, and punch biopsies were performed. The results of histologic examination were wide variety, five chronic cervicitis, one condyloma, one mild dysplasia, three moderate dysplasia, three severe dysplasia, three carcinoma in situ, and one microinvasive carcinoma. Only two cases were treated during pregnancy; one with condyloma underwent Laser vaporization and another with microinvasive carcinoma underwent LEEP conization. Other cases were given conservative treatment during pregnancy. Excluding one case for persistence smear class IIIa of histology condyloma, all the cases showed regression of dysplasia and carcinoma in situ with treatment after delivery. We conclude that lesions up to carcinoma in situ do not require intervention during pregnancy but microinvasive carcinoma is suspected, diagnostic LEEP conization is necessary, even during pregnancy.

Carcinoma↗
PubMed2005

A study of abnormal cervical cytology in pregnant women.

During the 4-year routing study of smears in 2,919 pregnant women, 33 cases of abnormalities of the uterine cervix were detected (1.13%). The patients were followed with uterine cervical cytology and colposcopy, and in case of need, sometimes punch biopsies were performed. As a result of the cytologies, 33 cases with abnormalities were detected. There were 26 cases classified as class IIIa and 7 cases were class IIIb. All cases underwent colposcopy. For the 17 cases that showed lesions by colposcopy, punch biopsies were performed. The results of histologic examination were wide: 5 chronic cervicitis, 1 condyloma, 1 mild dysplasia, 3 moderate dysplasia, 3 severe dysplasia, 3 carcinoma in situ, and 1 microinvasive carcinoma. Only two cases were treated during pregnancy, condyloma underwent Laser vaporization and microinvasive carcinoma underwent Loop electrosurgical excision procedure (LEEP) conization. Other cases were conservative treatment during pregnancy. Excluding one case for persistence smear class IIIa of histology condyloma, all the other cases with regression of dysplasia and carcinoma in situ with treatment after delivery. We conclude that lesions up to carcinoma in situ do not require intervention during pregnancy but microinvasive carcinoma is suspected, diagnostic LEEP conization is necessary, even during pregnancy.

Adolescent↗
PubMed2003

[Modalities and limits of conservative treatment of adenocarcinoma in situ of the uterine cervix: analysis of nine cases and review of the literature].

OBJECTIVE: The aim of this study is to assess the results of conservative management of adenocarcinoma in situ (AIS) of the uterine cervix in young patients. PATIENTS AND METHODS: Data of 16 patients treated for AIS were reviewed: 10 were treated initially conservatively (cold knife conization in five patients, loop excision in three patients and cervical amputation in two patients) and six radically. One patient treated initially conservatively with loop excision and positive margins underwent a completion surgery (hysterectomy). RESULTS: None patient had recurrence whatever the type of surgery (radical or conservative) with a mean follow-up of 74 months. Two pregnancies were observed. DISCUSSION AND CONCLUSIONS: Conservative surgery for patients with AIS could be considered in young patients. But [for] reviewing literature several conditions should be respected: careful follow-up after conservative treatment; cold knife conization; length of cone specimen >25 mm and free margins. If those criteria are respected the risk of recurrent disease under the form of invasive carcinoma is low.

Adenocarcinoma↗
PubMed2004

Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ).

BACKGROUND AND OBJECTIVE: Human Papillomavirus (HPV) persistence after high-grade cervical intra-epithelial neoplasia (CIN) removal may be associated with residual lesions or risk of disease recurrence. Knowledge regarding the factors associated with HPV persistence following CIN treatment is still limited. The main purpose of this longitudinal study was to assess the association between characteristics of the patients and their cervical lesions with high-risk HPV-type persistence, detected by commercially available Hybrid Capture II (HC II), after CIN 2 and 3 treatment with large loop excision of the transformation zone (LLETZ). STUDY DESIGN: For this cohort study, a total of 94 women submitted to LLETZ between March 2001 and September 2002 were included. Only women with at least one follow-up visit at 6 or 12 months and confirmed CIN 2 or 3 in the cone specimen were considered. In each visit women answered to a questionnaire and undertook Pap smear and HC II specimens collection. McNemar's, chi-square and Fisher tests were used for univariate analysis. Generalized Estimating Equations (GEE) were used for multivariate analysis. All calculations were performed within 95% confidence intervals (95% CI). RESULTS: Histological evaluation showed 12 (13%) women with CIN, 2 and 82 (87%) with CIN 3 and conization margins were compromised in 27 (29%) cases. Eighty-seven (92%) women showed positive HC II tests prior to LLETZ. Of women initially HPV negative, none had a positive HC II during follow-up. The proportion of positive HPV tests was reduced from 92% to 20%(P < 0.01) at the first visit and to 22% (P < 0.01) at the second visit after LLETZ. Multivariate analysis showed that smoking and age above 35 years (irrespective of margin status) were strongly associated with positive HPV during follow-up. CONCLUSION: HPV persistence following LLETZ was associated with smoking and with the interaction between age and conization margins.

Adolescent↗
PubMed2005

The influence of time intervals between loop electrosurgical excision and subsequent hysterectomy on the morbidity of patients with cervical neoplasia.

OBJECTIVE: To improve clinical prospects by reducing intraoperative or postoperative complications, subsequent hysterectomy is generally conducted within 48 h or 6 weeks after cervical cold-knife conization. The loop electrosurgical excision procedure (LEEP) is widely used for cervical conization. However, no study has ever been undertaken on the relation between postoperative sequelae and the time between LEEP and hysterectomy. Therefore, this study was undertaken to evaluate the correlations between postoperative sequelae and the interval between LEEP and hysterectomy. METHODS: The medical records of 338 patients, who underwent type 1 extended hysterectomy after LEEP at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine, were retrospectively reviewed. The subjects were divided into three groups according to time from LEEP to hysterectomy: group 1 (within 48 h, n = 210), group 2 (between 48 h and 6 weeks, n = 88), and group 3 (>6 weeks, n = 40). RESULTS: The three groups showed no significant differences with respect to patient characteristics (age, delivery history, body mass index, and a history of surgery). Postoperative complications such as fever, dysuria, and surgical region complications (effraction, infection, and rubefaction) were not significantly different among the three groups. Other complications, namely, ureter injury and abdominal wall hematoma, were found in one case in each group 1. CONCLUSION: The postoperative clinical courses were not significantly different regardless of time interval between LEEP and subsequent hysterectomy. Therefore, hysterectomies can be conducted at any time when the patient is in an appropriate condition, i.e., not precisely within 48 h or >6 weeks after LEEP.

Adult↗