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At least 1,225 records · Page 68Linked to original sources
PubMed1994

LEEP: early experience with a new approach to cervical lesions.

The loop electrosurgical excision procedure (LEEP) is a new diagnostic and therapeutic approach for the management of cervical lesions found during the evaluation of abnormal findings from Papanicolaou smears. The procedure may be an alternative to laser therapy, cold knife conization, cryotherapy or hot cautery. The first 235 consecutive LEEPs performed at the Gundersen Clinic were reviewed 6 months after the last procedure was done. Twelve of 187 patients with follow up Papanicolaou smears and clinic visits had persistent disease. Nine of 187 patients had a repeat LEEP. LEEP was found to be a highly effective means for diagnosis and treatment as 98% of the patients were free of evidence of recurrent cervical lesions 6 months after the initial LEEP.

Electrosurgery↗
PubMed1993

A long-term evaluation of the CIN-lesions. A clinicopathological study.

Among patients treated over a 20-year period cytological screening demonstrated a high-grade cervical dyscariosis (III-V Papanicolaou group) in 565 (2.3%) cases. In a group of 159 of these patients, all with cervical erythroplasia, a detailed study was possible and punch-biopsy (without colposcopy) was performed. Comparative analysis of cytology and pre-operative histology revealed good correlation. The patients in whom punch-biopsy demonstrated high-grade CIN and also those with negative histology, but with dyscariosis permanently occurring in cervicovaginal smears, underwent surgical treatment (conization). The results of histology in the punch-biopsies and in the surgical specimens of the cervix were discordant, mostly in low-grade CIN. Most patients are alive and well and remain in permanent clinical control. Conclusion--Cytology is a useful method of selecting the high-risk patients, who should subsequently be followed clinically, by cytology and histology. Surgical treatment seems to prevent invasive cancer: however these patients should remain under permanent control.

Adult↗
PubMed1993

[Villous glandular adenocarcinoma of the uterine cervix. A subtype with favourable prognosis?].

The frequency of adenocarcinoma of the uterine cervix is increasing, and accounts for 10-20% of all cervical carcinomas. Adenocarcinoma usually affects women in their fifties and sixties. Mortality is high, with a five-year survival between 49 and 65%. Important prognostic factors are tumour grade, tumour diameter and clinical stage. The prognostic value of histologic subtyping is still under debate. Villoglandular (papillary) adenocarcinoma is a recently described form of well-differentiated adenocarcinoma in the cervix. This lesion apparently affects young women and carries an excellent prognosis. We describe five patients with villoglandular adenocarcinoma in the cervix, clinical stage IB and IIA. Mean age was 34.2 years and mean depth of cervical infiltration was 1.25 cm. Four patients were treated with radical hysterectomy and bilateral pelvic lymphadenectomy and one with simple hysterectomy. All five received postoperative chemotherapy. There is no evidence of recurrent tumour after a follow-up of 18 to 28 months. Cervical conization or simple hysterectomy is probably adequate treatment for this subtype of adenocarcinoma.

Adenocarcinoma, Papillary↗
PubMed1993

[Clinical significance of magnetic resonance imaging (MRI) in evaluation of the extension of uterine cervical cancer].

Magnetic resonance imaging (MRI) was performed in 62 patients with uterine cervical cancer and the preoperative MRI findings were compared with the pathological findings following surgery. The surgical stages of 62 patients were 2 at stage 0, 18 at stage Ia, 19 at stage Ib, 9 at stage IIa, 11 at stage IIb, 2 at stage IIIa, and 1 at stage IIIb. The MRI findings in the present study included: (1) the existence of a high intensity area (HIA) in the uterine cervix or minimum thickness of residual normal cervical tissue, (2) necrotic cavity, (3) pyometra, (4) irregular margin of the cervix, (5) parametrial invasion, (6) vaginal invasion, (7) bladder invasion, and (8) lymphnode enlargement. No HIA was observed in any patient with stage 0 or stage Ia, in 8 patients with stage Ib, and in 2 patients with stage IIa, while all patients with cancer tissues greater than 10mm in diameter had a HIA. In 39 patients in whom hysterectomy was undergone without conization, the findings of MRI correlated significantly (r = 0.929, p < 0.001) with the minimum thickness of residual normal cervical tissue by the pathological measurement. When the irregular margin of the cervix was regarded as a disruption of the cervical myometrium by cancer tissue, accuracy was 87%. Furthermore, the degrees of accuracy for parametrial invasion, vaginal invasion and bladder invasion were 92%, 90% and 94%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Experience with using laser surgery in the treatment of benign diseases of the cervix uteri when it is deformed].

Contact AYG laser was used in surgery on the deformed cervix uteri for cervicosis. The suggested method of using a contact laser scalpel at the main stages of the operation for partial stratification and miniconization provides a reliable hemostasis, minimal injury to the tissues, sterility of the operation site, and in stratification of the cervix uteri--a sufficiently easy dissection of the desired layer. The authors emphasize the usefulness of a differentiated approach to the choice of the method of surgical intervention (conization, plasty by partial or complete stratification), permitting the surgeon to combine the radical character of a surgical intervention with sparing of the anatomical shape of the cervical canal, and thus providing functionally stable results.

Cervix Uteri↗
PubMed1993

Evaluation of the cervical canal with the endocervical brush.

OBJECTIVE: To evaluate and compare the cytologic information obtained from the endocervical brush and the histologic information obtained from the standard endocervical curettage (ECC) used to evaluate the endocervical canal in patients with an abnormal Papanicolaou test. METHODS: Three hundred eighty-eight patients underwent evaluation of an abnormal Papanicolaou test with a repeat Papanicolaou test, a separate endocervical brush test, colposcopy, directed biopsies, and ECC. The study group comprised 101 patients who subsequently underwent conization and/or hysterectomy. The brush and ECC results were evaluated against the final pathologic findings. RESULTS: Sixty-five patients had a satisfactory colposcopy and 36 had an unsatisfactory colposcopy. Results for these two groups are reported separately. For the total group, the sensitivities of the ECC and brush were 49 and 93%, respectively (P < .001); the specificities were 82 and 26% (P < .001), the positive predictive values were 69 and 52% (P = .99), and the negative predictive values were 65 and 82% (P = .004). CONCLUSION: The endocervical brush appears to be a sensitive test for disease in the endocervical canal but yields a high false-positive rate. The role of the brush in this setting will require further study. The ECC is more specific but is also a suboptimal test for identifying disease in the endocervical canal.

Adolescent↗
PubMed1993

Outpatient laser cone biopsy under local anesthesia.

The authors report on 60 patients who had abnormal findings on cervical cytologic examination, necessitating conization of the cervix. The procedure was done in an ambulatory setting, with a carbon-dioxide laser unit and local anesthesia. The average operative time was 16.9 minutes. Fifty-one (85%) patients experienced no complications, and there were no cases of excessive bleeding. In all patients, the specimen was satisfactory for histologic review. Only 5% (three) of patients would have preferred to have the procedure performed under general anesthesia. Laser cone biopsy of the cervix can be performed in an outpatient setting, with local anesthesia. Morbidity is minimal and there is potential for economic saving when compared with conventional methods for biopsy of the cervix.

Adult↗
PubMed1993

[Botryoid rhabdomyosarcoma of the cervix. Clinico-pathologic study of a case].

The botryoid rhabdomyosarcoma of the cervix is a rare tumour occurring in young woman or during genital activity. It mainly causes vaginal bleeding or appears as a polypoid grape-like mass with a gelatinous cut-surface. The diagnosis is based on the presence of a submucosal cambium layer and a rhabdomyoblastic differentiation, corresponding to an intracytoplasmic double cross-striation. Metaplastic cartilaginous islands are sometimes observed. The immunostaining ensures the muscular origin of the tumour, characterized by the expression of actin and desmin. Apart from mullerian adenosarcomas, the main differential diagnosis is represented by the benign polypoid formations of the cervix: the genital rhabdomyoma and the fibroblastic lesion, called fibro-epithelial polyp with atypical stroma. The treatment actually includes both chemotherapy and surgery which is often limited to a conization.

Adolescent↗
PubMed1993

Abnormal cervical cytology in pregnancy: a 17-year experience.

OBJECTIVE: To evaluate the safety and accuracy of colposcopy and colposcopically directed biopsy in pregnant women with abnormal cervical cytology. METHODS: A retrospective analysis of 612 gravidas with abnormal cervical cytology was conducted. Colposcopy and directed biopsy were performed using standard techniques. Two patients underwent diagnostic conization during the second trimester. One hundred twelve patients had procedures that provided a final specimen. Endocervical curettage was omitted. The transformation zone was fully visualized in all patients by the 20th week of gestation. Directed cervical biopsy was performed on the following patients: 1) with colposcopic evidence of invasion or cervical intraepithelial neoplasia (CIN) III, 2) with discordancy between colposcopy and cytology, 3) electing termination of pregnancy, and 4) whose anticipated reliability was even remotely questioned. RESULTS: A colposcopically directed biopsy was performed in 449 patients (73%). Ninety-one patients (15%) did not have biopsies because of normal colposcopic findings, and the remaining 72 patients (12%) had either CIN I or II. Thirty-nine of these patients (6%) were lost to follow-up. Colposcopically directed biopsy and colposcopic impression had a 95% concordancy within one degree of severity; however, 14% of CIN I colposcopic impressions and 54% of normal colposcopic findings turned out to be CIN III and CIN I or II, respectively. Ninety-five percent of the biopsy diagnoses correlated with the final pathology to within one degree of severity. CONCLUSION: The data confirm previous findings that colposcopically directed biopsy is a safe and reliable method of evaluating pregnant patients with abnormal cervical cytology.

Adolescent↗
PubMed1993

Large-loop excision of the transformation zone: effect on the pathologic interpretation of resection margins.

OBJECTIVE: To determine the effect of large-loop excision of the transformation zone (LLETZ) on the ability to interpret adequately the pathologic specimen and surgical margins. METHODS: Fifty consecutive LLETZ specimens were used for repeat histopathologic assessment with emphasis on the interpretability of the surgical specimen and margin. All reevaluations were performed by a single pathologist. Complete lesion evaluability was defined as satisfactory accuracy of the histologic diagnosis and the ability to evaluate thoroughly all surgical margins. Medical records of the patients from whom the specimens were obtained were reviewed and analyzed for possible correlates to the status of specimen interpretability. RESULTS: Histologic accuracy was sufficient in 46 cases (92%). Extensive heat distortion precluded full assessment of the ectocervical margins in ten (20%) and the endocervical margins in 22 (44%) of the cases. There was no difference in complete lesion evaluability whether LLETZ was performed solely for treatment in cases suitable for ablative procedures or for both diagnosis and treatment in patients who traditionally would have undergone a cone biopsy. If the latter group (N = 25) was analyzed separately, extensive heat distortion made histopathologic diagnosis impossible in four cases (16%) and precluded full assessment of the ectocervical margin in eight (32%) and the endocervical margin in 12 (48%). CONCLUSION: The high rate of surgical-margin thermal destruction, with related limitation of interpretability, may represent a serious diagnostic and therapeutic limitation of the LLETZ procedure when considered as an alternative to cold knife conization.

Biopsy↗
PubMed1993

[Intra-epithelial cancer of the cervix uteri. Epidemiological and therapeutic evolution. Apropos of 207 cases].

Through a retrospective study of 207 CIN III of the cervix uteri, with a medial follow-up of 6 years, the authors are showing the evolution in the management of that pathology. Different reasons are invoked: 1) the practice of systematic Papanicolaou smears reveals dysplasia of the cervix in younger women, justifying treatments that preserve obstetrical future; 2) the histological classification is now well established, the old terminologies is being replaced by the international term of CIN III. 3) the colposcopy can localize the transformation zone, allowing more conservative treatments. The treatment of reference was initially hysterectomy and is now conization for non-menopausal women; but this conservative evolution is not yet finished.

Adult↗
PubMed1995

[Value of endocervical curettage in colposcopic diagnosis of cervix diseases].

The present study was undertaken to determine the credibility of endocervical curettage as a part of evaluation of patients with abnormal Pap smears. A series of 108 patients were carefully examined with colposcopy, ectocervical biopsies and endocervical curettage, and all of them underwent cervical conization following diagnostic study. The histologic diagnosis results between endocervical curettage and cervical cone was compared. The estimate was 85% for sensitivity, 35% for specificity, 62% for positive predictive value and 65% for negative predictive value of cervical curettage. The observations suggest that endocervical curettage credibility is poor and we need to asses the outpatient evaluation and treatment carefully.

Adenocarcinoma↗
PubMed1995

[The significance of invasion and vessel permeation in squamous cell carcinoma of the uterine cervix with invasion to a depth of 3 mm or less].

Nine-five patients with squamous cell carcinoma of the cervix invading to a depth of 3 mm or less (microinvasive carcinoma) were retrospectively viewed in regard to the depth of stromal invasion, the width of horizontal spread, confluent invasion, vessel permeation and lymph node metastasis. The type of treatment and outcome were also evaluated. Confluent invasion was found in 6 patient (6%), and vessel permeation in 9 patients (9%). Lymph node dissections were performed on 85 patients, but no lymph node metastasis was found, irrespective of the presence of confluent invasion or vessel permeation. Fifty-five patients with no vessel permeation were treated by conization or total or modified racial hysterectomy, and none had a recurrence of the disease. Our results suggest that the presence of confluent invasion or vessel permeation does not influence the incidence of lymph node metastasis, but data in the literature indicate that confluent invasion and vessel permeation are risk factors for lymph node metastasis and invasive recurrence of the disease. We conclude that patients with invasion of depth 3m or less, with no confluent invasion and no vessel permeation, can be treated by conservative operation.

Adult↗
PubMed1995

[Therapeutic management of recurrent uterine cervix carcinoma following surgery alone or surgery with complementary endocavitary curietherapy].

Sixty-eight cases of recurrence of cancer of the uterine neck, among which 8 after conization and 60 after Wertheim's enlarged hysterectomy, in a group of 472 patients are examined. No one of these 472 patients was subjected to external radiotherapy, because metastatic lymph nodes were not found at the time of the surgery of the primary tumor. The aim of the work was to examine the possibilities of identifying a subgroup of patients, among those without metastatic lymph nodes, for whom external radiotherapy, besides brachytherapy, could be considered useful on the basis of the extent of the primary tumor and of the histological type. Surgery has cured 11 patients; radiotherapy and radiochemotherapy possibly combined with surgery have cured 8 patients. Histological type and the extension of the tumor do not seem to influence the incidence of the relapses, however the authors opine that a multifactorial analysis, with includes other factors (HB rate, angiogenesis aneuploidism) could indicate a subgroup of patients for whom, in spite of absence of metastatic lymph nodes, could be concluded that the external precautional radiotherapy is useful.

Adult↗
PubMed1977

Colposcopic evaluation of patients with abnormal cervical cytology.

A total of 1580 new patients underwent colposcopic evalution in the Dysplasia Clinic at Nassau County Medical Center. Of these patients, 186 had abnormal Papanicolaou smears associated with pregnancy, 150 were referred because of in utero exposure to diethylstilbestrol, and 1244 were referred because of abnormal cervical cytologic smear or suspicious cervical or vaginal lesion. Further analysis of this latter group revealed that 1184 (95%) patients had satisfactory colposcopic evaluation, and directed biopsy showed the following: 10 cases of invasive cervical carcinoma, 9 of carcinoma in situ with microinvasion, 118 of cervical carcinoma in situ, 110 of severe dysplasia, and 424 cases of mild to moderate cervical dysplasia. All of these patients subsequently were treated accordingly. Evaluation of final histologic specimen revealed a very high correlation with colposcopically guided biopsies. In 54 patients, where colposcopic evaluation was unsatisfactory, diagnostic cold knife conization was performed. Final histologic diagnosis disclosed a more advanced lesion in 30 patients (or 56%) of this group. The result of this study shows that satisfactory colposcopic evaluation is a highly accurate method of evaluation of abnormal cervical and vaginal cytologic smear.

Adolescent↗
PubMed1977

Effect of preoperative scrub on the bacterial flora of the endocervix and vagina.

A study was designed to evaluate the effectiveness of a preoperative vaginal and perineal scrub in reducing bacteria. An iodophore soap followed by an iodophore solution was used for the scrub. Cultures were taken from the vagina and endocervix of 50 patients before and after the scrub, and cultured for aerobes, anaerobes, and mycoplasma. An average of 5.62 bacterial species per patient was cultured from the vagina before the scrub and 3.9 from the endocervix. The corresponding numbers after the scrub were 0.08 species per patient from the vagina and 1.84 from the endocervix. The reduction of organisms from the vagina was unrelated to the reduction in the endocervix. The scrub was by far more effective in the vagina than in the endocervix. The vagina was bacteria free in 92% of cases while the endocervix was bacteria free in only 8% of cases. No organisms could be recovered from the cervix of 8 patients who had removal of the endocervix by hot conization followed by the iodophore scrub. There was an average of 4.25 species per patient from the 8 cultures of the endocervix prior to the cone and scrub.

Adolescent↗
PubMed1996

Ukrain treatment in carcinoma of the cervix (case report).

A grade IV Papanicolaou cervical cancer was treated with endocervical cone biopsy (electrocoagulation) in a 28 year-old lady. Three years later examination revealed cervical carcinoma in situ and a conization was recommended, which the patient refused. She was treated with Ukrain instead. The grading regressed steadily and after one year of Ukrain therapy all stagings were normal. Three years after the start of Ukrain therapy she gave birth to a healthy child. Eight years later she has no recurrence and is healthy.

Adult↗
PubMed1996

Management of stage IA cervical carcinoma.

Approximately 10%-15% of women with stage I cervical cancer have microinvasive lesions (stage IA). In studying these patients, we aim to identify the cancers that have little or no chance of harboring metastatic disease from the primary site. These patients may be treated by more conservative means, thereby lowering morbidity and cost and preserving the women's fertility. The diagnosis of stage I cervical cancer is surrounded by controversies concerning the diagnostic criteria, the low level of agreement among pathologists interpreting the same material, and the limited evidence in the literature for definitions of risk factors. The available information suggests that women with squamous cell lesions that invade at a 3-mm depth or less and who have no evidence of lymph-vascular invasion may be successfully treated with cervical conization. Women with a depth of invasion of more than 3 mm or with lymph-vascular invasion should be treated with methods that address the potential for disease in the lymph nodes and paravaginal tissues.

Carcinoma, Squamous Cell↗