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PubMed1997

Conservative treatment for cervical cancer IA1: four cases report.

Cervical carcinoma IA1 is defined as invasive cervical cancer with measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm in diameter. It has been managed by extrafascial or modified radical hysterectomy. For young female patients who want to preserve future fertility, conservative treatment using therapeutic conization should be considered. In Taiwan, there has been little information about conservative treatment for cervical carcinoma IA1. We present 4 cases of young women with cervical carcinoma IA1 treated by conization alone. Pathological reports of all specimens demonstrated squamous cell carcinoma with free margins, stroma invasion less than 3 mm and no evidence of lymphovascular space invasion (LVSI). After 5-year follow-up with pelvic examination, pap smear, and colposcopy, there was no evidence of disease recurrence. We believe that conservative treatment for cervical carcinoma IA1 without LVSI is appropriate for selected patients to preserve future fertility.

Adult↗
PubMed1997

Villoglandular adenocarcinoma of the cervix: cytologic presentation.

Villoglandular adenocarcinoma of the uterine cervix is a recently described neoplasm which occurs primarily in young women and has an excellent prognosis. In many instances, these lesions may be treated conservatively with cervical conization rather than hysterectomy, a therapeutic option of particular importance for young women who wish to preserve reproductive capability. This paper describes the cytologic findings on cervical smears from three women with villoglandular adenocarcinoma, two treated conservatively with cervical conization and one managed with hysterectomy. Characteristic cytologic features in these cases included the presence of long villous fronds and papillae lined by columnar cells with intact cytoplasmic borders and minimal to moderate cytologic atypia. Also noted were strips and three-dimensional ball-like clusters of cells with smooth, intact communal cytoplasmic rims. Apoptotic bodies and scattered mitoses were observed. Recognition of the above features warrants inclusion of this entity in the cytologic differential diagnosis, with conservative histologic follow-up prior to more radical therapeutic measures.

Adenocarcinoma↗
PubMed1981

The abnormal Pap smear--what to do next?

The patient with an abnormal Papanicolaou smear must have proper and adequate diagnostic evaluation to determine the degree of cervical abnormality. Gross clinical evaluation alone is inadequate for definitive diagnosis because cytologic screening identifies patients with preclinical disease. Outpatient diagnostic evaluation must include colposcopy, colposcopic-directed biopsies, endocervical curettage, and pelvic examination. Conization of the cervix is required whenever these techniques are unsatisfactory or are unable to rule out invasive cancer. When outpatient diagnostic procedures including cytologic analysis rule out invasive disease, one may elect cryosurgery, electrocautery, or laser in treating cervical intraepithelial neoplasia. Nevertheless, conization or hysterectomy may be inpatient treatments for selected patients.

Adult↗
PubMed1988

Genital papillomavirus infection after treatment for cervical intraepithelial neoplasia (CIN) III.

UNLABELLED: Genital human papillomavirus (HPV) infection was studied in 150 women after conization for cervical intraepithelial neoplasia grade three (CIN III). Colposcopically directed biopsies were taken from the cervix and vulva for histopathological diagnosis. 77 specimens were further analyzed immunohistochemically for the presence of HPV capsid antigen. In ten randomly selected cervical biopsies cellular DNA was dot blot hybridized with HPV 6/11 and 16/18 DNA probes. Genital warts were seen in 10 (7%) of the patients. Among the routine cytological smears, HPV infection was only reported in 3 (2%). In 87/142 (61%) of the cervical tissues koilocytes were found. A further 9/142 (6%) associated with CIN. Of the vulvar biopsies 91/145 (63%) contained koilocytes. A further 12/145 (8%) were associated with vulvar intraepithelial neoplasia. HPV capsid proteins were detected in 35/77 (45%) of the cervical and in 20/41 (49%) of the vulva biopsies. All cervical DNA samples hybridized with probes for HPV 6/11 and two also reacted with the HPV 16/18 probes. CONCLUSION: A latent HPV infection of the cervix or vulva, can be detected in 85% of the women previously treated for CIN III by conization.

Adult↗
PubMed2004

Three-dimensional power Doppler imaging of early-stage cervical cancer.

OBJECTIVES: To characterize intratumoral vascularization in early-stage cervical cancer by three-dimensional (3D) power Doppler ultrasound. METHODS: One hundred and forty-one patients with carcinoma of the uterine cervix and 30 normal controls were studied by transvaginal 3D power Doppler ultrasound. The tumor volume of the cervical cancer was determined. The blood flow within the tumor or normal cervix was measured and expressed as the vascularization index (VI), flow index (FI) and vascularization flow index (VFI). RESULTS: Of the 141 patients with cervical cancer, 44 patients had undergone prior cervical conization. Eighty-seven patients had measurable cervical tumors, of whom five had had prior conization. Abundant intratumoral power Doppler signals could be detected, and the VI, FI and VFI were significantly elevated in cervical cancer patients compared with women with a normal cervix and patients in whom no cervical tumor could be detected (P < 0.05, one-way ANOVA). We observed four types of intratumoral vascularity patterns, which did not significantly differ in VI, FI and VFI: localized, peripheral, scattered and single-vessel types. Cervical tumor volume was positively correlated with FI (linear regression, r = 0.373, P = 0.001), but not with VI or VFI. CONCLUSIONS: 3D power Doppler ultrasound provides a useful tool to investigate intratumoral vascularization and volume of cervical cancer.

Adult↗
PubMed1994

Adverse effect of electrosurgical loop excision on assignment of FIGO stage in cervical cancer: report of two cases.

Electrosurgical loop conization of the cervix is a new procedure that is being rapidly accepted for treatment of cervical intraepithelial neoplasia (CIN). Concerns include fragmentation of the specimen that is frequently mandated by the size of the transformation zone and difficulty in using the largest electrosurgical loops. Two cases are presented that demonstrate the inability to accurately assign depth of invasion in cervical cancer when the focus of invasion is transfected. As a result, the patient and physician were forced to decide on whether a radical hysterectomy and pelvic lymphadenectomy were needed based on incomplete information. It is recommended that electrosurgical loop conization be confined to patients where invasive carcinoma is not expected. The use of this new technique for patients with suspected invasive carcinoma needs further evaluation.

Adult↗
PubMed1994

Small FIGO stage IB cervical cancer.

The International Federation of Gynecology and Obstetrics (FIGO) currently defines stage IA cervical cancer as lesions invading up to 5 mm into the stroma and with no more than 7 mm width; vascular invasion does not affect the stage assignment. The Society of Gynecologic Oncology (SGO) definition of stage IA is more restrictive with regard to depth of invasion but ignores width. We reviewed 69 patients with lesions exceeding the FIGO definition of stage IA treated between 1958 and 1991; 46 patients also exceeded the SGO criteria for stage IA. The frequency of vascular invasion showed no correlation with the depth of invasion but was correlated with the width of the lesion. Treatment consisted of conization or simple hysterectomy only (n = 27), radical abdominal hysterectomy with lymphadenectomy (n = 25), radical vaginal hysterectomy (n = 13), and conization followed by radiotherapy (n = 4). No patient developed a recurrence during a follow-up of 2-35 years. Two of the 25 patients with lymphadenectomy had one positive lymph node each. The first patient had a primary lesion with 3 mm invasion and 17 mm width, no vascular invasion, and one node metastasis 2 mm in diameter; the second had a lesion with 4 mm invasion and 10 mm width, vascular invasion, and a tumor-cell embolus in the marginal sinus of a node. These results indicate that the problems involved in treating microinvasive carcinoma of the cervix also apply to cases of small stage IB disease. It will not be possible to devise a staging system that simultaneously serves as a guideline for treatment. The current FIGO classification of stage IA2 should be expanded rather than restricted.

Adult↗
PubMed1986

Pregnancy and delivery after cone biopsy of the cervix.

Seventy-seven women had 98 pregnancies after a cone biopsy of the cervix. There were 62 deliveries, 26 legal abortions, 9 spontaneous abortions and 1 ectopic pregnancy. Cervical cerclage was done for 22 out of 62 conized parturients (35.4%) and for none in the matched control group. There were 4 (6.4%) preterm deliveries in the cone biopsy group and 1 in the control group. The perinatal mortalities were 3.2% and 0% respectively. The mean duration of labour was 2.4 h shorter in the conized parturients than in the controls (P less than 0.05) but there were no difference in the mode of delivery in the two groups.

Abortion, Spontaneous↗
PubMed1975

Colposcopic evaluation of the abnormal Papanicolaou test in pregnancy.

Colposcopy, including colposcopically directed biopsies in selected cases, was employed to evaluate over 300 pregnant patients with abnormal Papanicolaou tests suggestive of mild dysplasia or worse (Class III to V). Over half of the patients had benign disorders determined by colposcopic examination. All cases of invasive disease were diagnosed by colposcopy and biopsy, and the patients were treated accordingly. Only 3 diagnostic conizations were necessary in the antepartum period. The majority of patients with cervical intraepithelial neoplasia were seen post partum, and appropriate therapy was instituted. In the pregnant patient with an abnormal Papanicolaou test, colposcopy has proved to be a reliable and safe method of evaluation and has virtually eliminated the need for conization.

Biopsy↗
PubMed1975

Influence of the size of cone specimens on postoperative hemorrhage.

To investigate whether the amount of the tissue removed at conization could influence the frequency of postoperative hemorrhage, the size of 221 cone specimens was measured in two different series. The 119 patients in the first series were operated upon mainly during 1972 and the second series of 102 patients mainly during 1973. The cones in Series II were empirically reduced following the technique proposed by Crisp and associates. Actual measurements demonstrated that the specimens in Series II were smaller than in Series I. The frequency of bleeding following conization was 4 per cent in the second series but as high as 21 per cent in the first series. Postconization hemorrhages, however, were unrelated to the size of the individual cone specimens in the different series. The operative technique used in Series II appears to be responsible for the decrease in the amount of postconization hemorrhages.

Adult↗
PubMed1976

Outpatient evaluation of patients with atypical Papanicolaou smears: contribution of endocervical curettage.

A series of 603 patients referred with atypical Papanicolaou smears was evaluated by repeat smears, colposcopically directed cervical biopsies, and endocervical curettage. These techniques as a unit can establish an accurate outpatient diagnosis superior to any of these modalities used alone and comparable with findings in conization and hysterectomy specimens. Endocervical curettage has made a unique contribution to the evaluation of such patients; these curettings have allowed examination of tissue fragments and are more reliable in diagnosing neoplasia than are endocervical smears. Invasive carcinoma and its precursors confined to the anatomic endocervical canal can be recognized by this technique, and conversely the absence of neoplastic epithelium in adequate endocervical curettings rules out occult carcinoma. Indications for conization of the cervix are discussed in reference to the other biopsy and cytologic findings, and guidelines are presented for patient management, stressing clinicopathologic correlation and cooperation.

Biopsy↗
PubMed1977

The 'problem' radical hysterectomy.

This is a study of 243 radical hysterectomy and pelvic lymphadenectomy procedures performed for gynecologic malignancy. The term 'problem' radical hysterectomy was applied to those patients with one of the following conditions: (1) recent cervical conization (within 21 days). (2) previous total or supravaginal hysterectomy, (3) pregnancy, or (4) previous pelvic radiation. There were 88 patients in theses categories. One hundred and fifty-five patients had none of these predisposing problems which might influence operative or postoperative complications. There were two deaths (0.82 per cent). There was no statistically significant difference in operative injuries to the bladder, ureters, or rectum or in the mean operative time and mean blood loss across the categories. However, there was a statistically significant difference across the categories in postoperative complicatons, both major and minor. The greatest incidence of such complications occurred in patients who had previous radiation therapy and the second greatest incidence was in patients who had recent cervical conization. Pregnant patients had the least number of complications.

Adolescent↗
PubMed1977

False positive cervical cytology: an important reason for colposcopy.

Over an 18 month period, 352 patients with a report of abnormal cervical cytology ranging from mild dysplasia to invasive carcinoma were evaluated with colposcopy and, if indicated, directed biopsies. From the group, there were 26 women in which a lesion consistent with the cytologic diagnosis was not found in each of these cases, an error in the interpretation of the Papanicolaou smear, resulting in a false positive report, was suspected. The cytology was reviewed and the results were compared to the original reports. Twelve cases were reinterpreted as negative for cervical neoplasia. A similar review of the histology failed to reveal a previously missed lesion. Cervical conization in four patients and repeat cytology and colposcopy in 22 patients confirmed the false positive interpretations of the original cervical cytology. The importance of colposcopy as a means of recognizing false positive cytology and avoiding an unnecessary cervical conization is emphasized.

Cervix Uteri↗
PubMed1982

Evaluation of topically applied trans-retinoic acid in the treatment of cervical intraepithelial lesions.

The prevention and/or suppression of preneoplastic foci in animals has been convincingly demonstrated with the use of a variety of compounds, including retinoids. We report here a phase I/II trial of beta-trans-retinoic acid delivered via a collagen sponge/diaphragm insert for neoplasia of the cervix. Eighteen patients with biopsy-proved grades 2 and 3 cervical intraepithelial neoplasia underwent four consecutive daily applications of trans-retinoic aicd to the cervix. Conization of the cervix was performed 4 weeks later. Significant vaginal toxicity in 10 of 18 (55%) patients was unrelated to the concentration or carrying media of the drug. A reduction in size of the intraepithelial lesion was noted by colposcopy in six of 18 (33%) patients with complete resolution of disease at conization in two patients. A new delivery system designed to avoid vaginal toxicity while defining the optimal concentration and dosing schedule for these patients is currently under investigation.

Administration, Topical↗
PubMed1986

Necessity of endocervical curettage in colposcopy.

The use of endocervical curettage was evaluated in 200 patients undergoing colposcopy, biopsy, endocervical curettage, and conization. It is suggested that endocervical curettage be performed only in cases of satisfactory colposcopy, since patients with unsatisfactory colposcopy should undergo conization.

Biopsy↗
PubMed1989

A ten-year experience treating cervical intraepithelial neoplasia with the CO2 laser.

Between 1977 and 1987, the CO2 laser was used to treat 4024 women who were diagnosed by cytology studies, colposcopy, and biopsy examination to have cervical intraepithelial neoplasia. On the basis of specific indications, these women were treated by vaporization, excisional conization, or combination conization procedure. The evolution of methodology for each laser technique was based on specific pathophysiology and long-term observation of results. A total of 3070 patients underwent vaporization, 2881 of whom had no evidence of disease after one laser exposure (93.8%). Of the 954 patients who had laser excisional procedures, 925 (97%) had no evidence of disease. The most common complications observed were intraoperative and postoperative bleeding; however, sutures were required in only 1.34% of the latter. The risks of cervical stenosis (1.1%), incompetent cervix (0%), and pelvic infection (0.05%) were very low. This 10-year study demonstrated that the CO2 laser was a highly effective method for treating cervical epithelial neoplasia and had the added benefit of preserving reproductive function and anatomic integrity.

Carbon Dioxide↗
PubMed1986

Endocervical curettage: does it contribute to the management of patients with abnormal cervical cytology?

Routine endocervical curettage has been advocated in the colposcopic evaluation of patients with abnormal cervical cytology. To assess the usefulness of this procedure, we reviewed the records of 518 patients referred to the Colposcopy Clinic with abnormal Pap smears. Data was reviewed retrospectively in 411 patients and collected prospectively in 107 patients. Dysplasia was present in 1.4% of ECC specimens obtained in patients with conclusive colposcopic examinations, and in 25.7% of specimens in patients with inconclusive examinations. Invasive cancer was not detected in any ECC specimen. Eighty patients with inconclusive colposcopic examinations underwent conization of the cervix; in this group, the final pathologic diagnosis was CIN III in 51.2%, microinvasive cancer in 2.5%, and invasive cancer in 1.2%. In patients with conclusive colposcopic examinations, the final pathologic diagnosis was CIN III in 17.2%, and no cases of microinvasive or invasive cancer were present. When the colposcopic examination is conclusive, the incidence of positive ECC is low and may not warrant performing ECC in all patients. When the examination is inconclusive, ECC rarely obviates the need for diagnostic conization as ECC rarely yields a diagnosis of invasive cancer.

Biopsy↗
PubMed1989

Invasive carcinoma of the uterine cervix following diagnosis and treatment of in situ carcinoma. Record linkage study within a National Cancer Registry.

56117 women registered in the Swedish National Cancer Registry with the diagnosis carcinoma in situ of the uterine cervix were followed up and the risk for developing an invasive carcinoma of the uterine cervix was studied. The studied cohort provided 453 362 women years at risk. The primary treatment for carcinoma in situ in Sweden is generally conization. Hysterectomy is carried out in relatively few cases and intracavitary radium treatment was given to a limited number during the period studied. Cryosurgery and laser conization were of less quantitative importance during this period. The incidence rates of invasive carcinoma of the uterine cervix were compared with expected rates calculated from the National Cancer Registry. The ratio between observed and expected number of cases of invasive carcinomas of the uterine cervix is roughly 2.5 from the first year of observation after treatment of the in situ carcinoma until 20 years. There seems to be a distinct difference in risk for development of an invasive carcinoma of the uterine cervix for different age groups. In age group 50 years and older at time for treatment of the in situ lesion, 66 cases of invasive cancer were observed against 10.7 expected - O/E = 6.2. In ages 49 years or less, 145 cases were observed compared with 77.4 expected - O/E = 1.9. The conclusion from this study is that women treated for an in situ lesion are at a higher risk for an invasive carcinoma than the common female population and should be carefully followed up for a long time after treatment of the in situ lesion.

Adult↗