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PubMed1999

Laser conization of cervical intraepithelial neoplasia grade 3: free resection margins indicative of lesion-free survival.

BACKGROUND: Various grades of cervical intraepithelial neoplasia may occur following laser conization for grade 3 lesions. The aim of this study was to assess lesion-free survival after laser conization in cases with/without free resection margins, and to test whether detection of human papillomavirus infection and/or p53 expression in the cone lesion were useful predictors of lesion-free survival. METHODS: In 598 women treated for cervical intraepithelial neoplasia grade 3 the state of the resection margins was recorded and related to the findings on follow-up, up to 15 years post-operatively. Lesion-free survival times were analyzed by the Kaplan-Meier method. The presence/absence of human papillomavirus infection and/or p53 expression in the primary lesion was investigated in every fifth case by in situ hybridization and immunohistochemistry respectively. RESULTS: Lesion-free survival was significantly more common after complete than incomplete excision of cervical intraepithelial neoplasia. In the latter, lesions tended to appear shortly after surgery, indicating the presence of residual disease. The few lesions appearing later were evenly divided between those with and those without complete excision. The results of the human papillomavirus and p53 investigations added no further information. CONCLUSIONS: The presence of cervical intraepithelial neoplasia in the cone margin gives strong indication of potential treatment failure. In its absence laser conization is highly effective in the treatment of cervical intraepithelial neoplasia, and has the advantage of providing a specimen suitable for the necessary histological investigation.

Conization↗
PubMed1994

Laser conization: the results of treatment of cervical intraepithelial neoplasia.

Combination laser conization was performed for the treatment of cervical intraepithelial neoplasia (CIN) in 473 patients, who were followed for a mean period of 70 months. In 16 cases (3.4%) CIN was demonstrated during follow up, and in 10 cases (2.1%) within the first year after treatment. The grade of CIN in the cone specimen was of no predictive value to recurrence. When excisional margins were involved recurrence was observed in 8.7% of cases, compared to 2.3% when margins were uninvolved. The risk of recurrence was significantly higher in patients with involvement of the endocervical cone margin. The only case of invasive disease during follow-up was observed more than 2 years after conization; cone biopsy was without involved margins. The results clearly demonstrate the method to be effective and justify an expectant management of all patients after conization by this method.

Adult↗
PubMed1989

The efficiency of the cytobrush and cotton swab in obtaining endocervical cells in smears taken after conization of the cervix.

In a randomised study of cervical smears after conization, the efficacy of the combined wooden spatula and cytobrush was compared with that of the combined wooden spatula and cotton swab. The conization technique involved a could knife and two Sturmdorf sutures. A total of 75 women participated, 57 had smears taken with both methods. Eighteen with only one of the methods. Out of 66 taken with a wooden spatula and a cytobrush. 48 (72.7%) contained endocervical cells and 53 (80.3%) contained either endocervical or metaplastic cells. Out of 66 smears taken with a wooden spatula and a cotton swab, only 25 (37.9%) contained endocervical cells and 40 (60.6%) contained endocervical or metaplastic cells. Both differences were significant (P less than 0.001 and P less than 0.05, respectively). The combined use of a wooden spatula and cytobrush is recommended for cytological smears after conization.

Cervix Uteri↗
PubMed1979

Preoperative hot conization of the cervix: a possible method to reduce postoperative febrile morbidity following vaginal hysterectomy.

Laboratory results indicate that the endocervix may be a source of bacterial contamination when vaginal hysterectomy is performed. In a series of 160 consecutive vaginal hysterectomies in premenopausal women, hot conization of the cervix was performed prior to the scrub with an iodophore. No preoperative antibiotics were used in this series. The postoperative febrile morbidity rate was 4.3 per cent and the average stay was 4.5 days. These results are compared with those of three other groups: (1) patients who received a three-dose parenteral prophylactic antibiotic course with the first dose two hours prior to surgery had a febrile morbidity rate of 8.6 per cent. (2) In patients who had prophylactic antibiotics for five days with the first dose given intraoperatively, the febrile morbidity rate was 10.1 per cent. (3) The febrile morbidity rate in the group with no antibiotic prophylaxis or hot conization was 49.1 per cent. Laboratory and clinical data suggest that preoperative conization may be effective in the reduction of postoperative febrile morbidity.

Anti-Bacterial Agents↗
PubMed1983

Cervical conization: when is uterine dilatation and curettage also indicated?

Although the primary goal of cervical cone biopsy is treatment of cervical intraepithelial neoplasia, conization plus uterine dilatation and curettage is usually considered as a single, standard procedure. We reviewed 128 cone biopsies (114 of these procedures included dilatation and curettage) over a 3-year period to see whether dilatation and curettage was necessary as an accompaniment to conization. The mean age for all patients was 32.8 years, and 6.25% (eight patients) had a history of abnormal uterine bleeding. There was no evidence of endometrial abnormality in any of the 114 dilatation and curettage specimens. These findings suggest that dilatation and curettage is not warranted as a routine adjunct to cone biopsy. We believe more precise criteria for combining dilatation and curettage with conization are required, and these include: patients in the peri- or postmenopausal period, suspected intrauterine abnormalities, and the presence of abnormal glandular cells in a cytologic sample. With the use of these guidelines, only 18 patients (14%) would have required dilatation and curettage.

Adolescent↗
PubMed1986

A comparison between laser excisional conization and laser vaporization for the treatment of cervical intraepithelial neoplasia.

One hundred twenty patients with cervical intraepithelial neoplasia who were treated by laser excisional conization were compared with a group of 100 women who had similar diagnoses and were treated by laser vaporization. Every operation in the series was performed in the outpatient surgical unit or in the office. In two thirds of the cases the procedures were carried out with the patients under local anesthesia. The parameters studied included time required to perform the procedure, immediate and delayed bleeding, postlaser stenosis, healing time, patient discomfort, persistence or recurrence of disease, and risk of invasion. The results of this study revealed few disadvantages to performing a laser excisional procedure. Immediate and delayed complications were less frequent with laser excisional conization. The time required to perform an excisional conization was on the average only 4 minutes longer than that for a vaporization. Most significantly, the laser excisional cone provides a large and excellent specimen for the pathologist to review.

Constriction, Pathologic↗
PubMed1993

Outpatient excisional management of cervical intraepithelial neoplasia. A prospective, randomized comparison between loop diathermy excision and laser excisional conization.

OBJECTIVE: The purpose of our study was to compare loop diathermy excision and laser excisional conization with respect to treatment time, reliability, effectiveness, and safety. STUDY DESIGN: Three hundred women with cervical intraepithelial neoplasia attending our colposcopy clinic were randomized to treatment with either loop diathermy excision (group 1, n = 150) or carbon dioxide laser excisional conization (group 2, n = 150), both performed with local anesthesia on an outpatient basis. Student's t or Mann-Whitney test were used to compare continuous data; the chi 2 test was used for categoric data. RESULTS: The mean age, parity, histologic features, depth of excision, and occurrence of residual or recurrent disease were similar; however, the mean time required to complete treatment and hemostasis (2.5 +/- 3.6 vs 24.2 +/- 11.8 min), patient discomfort, blood loss (2.77 +/- 3.76 vs 27.15 +/- 17.51 ml; p < 0.001), and considerable thermal artifact affecting histologic interpretation of excision margins (5 cases vs 25 cases; p < 0.01) were significantly less in group 1 than in group 2. CONCLUSION: In our experience outpatient loop diathermy excision is an equally effective, quicker, safer, and more reliable excisional technique than laser excisional conization.

Adult↗
PubMed1976

Diagnostic and therapeutic efficacy of cervical conization.

Cervical conization was perfromed on 756 patients at the University of Kentucky Medical Center from July 1, 1964, to January 1, 1973. Sixty-six patients were pregnant at the time of conization. Eighty-six per cent of patients with cytologic findings of carcinoma in situ had histologic verification of carcinoma in situ or severe dysplasia, and there was absolute correlation between cytology and histology in 75 per cent of patients will occult invasive cancer. Cervical biopsies without colposcopic direction predicted either severe dysplasia or carcinoma in situ in 77 per cent of cases but were accurate in only seven of 24 patients with occult invasive cancer. Carcinoma in situ was present in 30 per cent of hysterectomy specimens following conization but recurred in only seven per cent of patients followed without hysterectomy. Recurrent carcinoma in situ following hysterectomy was more common in patients with residual intraepithelial cancer in the uterus but was independent of the size of the vaginal cuff removed. Major postconization complications requiring hospitalization occurred in 3.4 per cent of nonpregnant patients and in 7.5 per cent of pregnant patients.

Adult↗
PubMed1992

[Removal of HPV infection of the portio vaginalis by laser therapy of scalpel conization].

Between May 1988 and December 1990, 855 patients were submitted to HPV-hybridisation. HPV 16/18 (10.4%) was detected more frequently (p = 0.0024) than HPV 31/33/35 (6.1%) and was more often associated with cervical intraepithelial neoplasia--CIN--III degrees (p = 0.0014). 42 patients with CIN were examined after treatment with cold-knife conization. PAP-smear, colposcopy and HPV-hybridisation were performed. None of the patients showed signs of CIN after treatment. Only one patient showed an HPV persistence. In three of 7 patients treated with laser conization and four of 12 patients treated with laser vaporization, examination after treatment showed signs of CIN. In 6 cases, an HPV persistence was detected. With regard to results of other authors, cold-knife conization is the most effective treatment of HPV infection of the cervix uteri.

Cervix Uteri↗
PubMed1986

Diagnostic conization of the cervix: review of 460 consecutive cases.

During a five-year period, 460 patients underwent cervical conization on the Gynecology Service at Memorial Hospital. The pertinent medical history of the 393 patients was reviewed as it related to the diagnosis of cervical intraepithelial neoplasia. All patients had repeat Papanicolaou smears and 94.4% had complete colposcopic examination using standard colposcopic procedures, endocervical curettage, and directed biopsies. For the purpose of this review, patients were separated into seven groups according to the primary and most significant indication for conization. The indications for the procedure and the histopathologic findings are discussed for each category. The usefulness of conization in the authors' institution varied according to the indication for which it was carried out. In this series of 393 patients, 18 patients (4.7%) initially diagnosed to have only intraepithelial disease, were found to have invasive carcinoma.

Adenocarcinoma↗
PubMed1978

Colposcopy or cervical conization? An economic comparison.

Costs of colposcopic evaluation of patients with abnormal Papanicolaou smears versus evaluation by conization are compared. The average colposcopic evaluation costs $106, and the average conization costs $923.70. Additional savings ensue if a colposcopic diagnosis, rather than conization of the cervix, precedes a definitive hysterectomy. All criteria for an adequate colposcopic examination and tissue diagnosis must be met to make this comparison.

Cervix Uteri↗
PubMed1983

Reliability of cytological follow-up after conization of the cervix; a comparison of three surgical techniques.

A retrospective analysis was made of 154 consecutive conizations between 1974 and 1982. Three surgical methods were compared: (A) Sturmdorf sutures; (B) interrupted vertical sutures; and (C) an 'open' method using only cauterization and no additional stitches. The mean blood loss during conization was not reduced by ligation of descending branches of the uterine arteries. Post-conization haemorrhage occurred in only 3% and did not differ between the three groups. Cervical smears with only ectocervical squamous epithelium or too little material to allow diagnosis were considered inadequate. Unreliable follow-up was defined as inadequacy of more than 25% of a patient's smears. Thirty per cent of all follow-up smears were inadequate (group A 33%; B 41%; C 16%). In 46% of the patients, cytological follow-up was unreliable (group A 48%; B 61%; C 18%) and additional measures such as dilatation of the cervix, endocervical curettage, or hysterectomy were required. The differences between group C and the other two groups were statistically significant (P less than 0.01; chi 2 test).

Adult↗
PubMed1993

Studies on repair of the uterine cervix after CO2 laser conization with anti-keratin monoclonal antibodies.

Histological repair of the cervical epithelium after CO2 laser conization was studied using resected uterus specimens. (1) Squamous epithelium (ectocervical side) and reserve cells (endocervical side), were seen immediately after conization; (2) HE staining showed that the S-C junction was formed within 4 weeks. (3) Endocervical epithelial repair of the S-C junction tended to be delayed, and the new S-C junction was deeper in the endocervical canal than before conization; (4) The stroma was repaired within 7 weeks, by prompt collagenization.

Adult↗
PubMed1979

Pregnancy and delivery after conization of the cervix.

Of 327 patients who had undergone conization of the cervix in 1968-74 in the Department of Obstetrics and Gynecology, Turku University Central Hospital, 249 replied to a questionnaire. Eighty-nine of these had had total of 112 pregnancies after conization. Conization had only minimal influence on the pregnancies and none on the deliveries. Over 90 per cent of the newborns delivered were full term and without anomalies. The incidence of spontaneous abortions also did not differ from normal.

Abortion, Spontaneous↗
PubMed1992

Clinical evaluation of contact Nd.YAG laser conization for cervical intraepithelial neoplasia of the uterus.

Contact Nd.YAG laser conization (laser cone) was performed in 500 patients with preoperatively diagnosed cervical intraepithelial neoplasia (CIN) since September 1983. The patients treated were followed for 12 to 96 months (39.2 months on average). Average operation time was 11.4 minutes. A cure with laser cone (single treatment) was achieved in 98.6%, including cases with microinvasive and invasive carcinoma, post-operatively. There were only 7 (1.4%) true residual cases of 47 cases (9.4% of total cases) with incomplete excision. High spontaneous cure rates (85.1%) in cases with incomplete excision are considered to be a characteristic of laser cone treatment. The contact laser cone method also got good specimens for histologic examinations. They gave a large amount of information for our follow-up. The results indicate that contact Nd.YAG laser conization for CIN is an excellent conservative therapy from the point of cure rate, safety, indication, operation time and cone specimen, even compared with CO2 laser conization.

Female↗
PubMed1993

Cervical conization and preterm delivery/low birth weight. A systematic review of the literature.

OBJECTIVE: Evaluate the effect of cervical conization on preterm birth/low birth weight (LBW). DESIGN: A systematic review of the literature using external or internal controls. RESULTS: The typical odds ratio for preterm delivery in women with prior cervical conization using external controls was 3.23 (95% confidence interval 2.29-4.55). Using internal controls the typical odds ratio for LBW was 2.97 (95% confidence interval 1.09-8.05). Using external controls the typical odds ratio for LBW was 2.31 (95% confidence interval 1.33-3.99). CONCLUSION: Women with cervical conization are at higher risk for preterm birth than external controls, and the surgical intervention as such is a major determining factor.

Cervix Uteri↗
PubMed2001

Outcomes of carbon dioxide laser conization for the treatment of cervical intraepithelial neoplasia grade III.

PURPOSE: The aim of this study was to determine the rates of incomplete excision of cervical intraepithelial neoplasia (CIN) III after carbon dioxide laser conization, and the risk of reappearance of CIN depending on the excision margins. METHODS: A total of 153 women who underwent carbon dioxide laser conization for CIN III between 1988 and 1998 at our hospitals were eligible for inclusion in the study and their notes were retrospectively studied. RESULTS: Histological examination of the excision margins revealed complete excision in 134 (87.6%), uncertain margins in one, and extension of CIN to the margins in 18 (11.8%) cases. The treatment failure rate in the cases with clear margins was 2.2% (3 of 134), and in the cases with involved margins 44.4% (8 of 18) (p < .001). CONCLUSION: Carbon dioxide laser conization despite the worldwide use of LLETZ still has a place in the treatment of CIN. Very high rates of complete excision were achieved. As incomplete excision does not always result in treatment failure, neither do clear margins always indicate eradication of the disease.

Adult↗
PubMed1992

[Acceptance of ambulatory laser conization under local anesthesia by Danish women].

The aim of the study was to evaluate the acceptability of CO2 laser excisional conization for cervical intraepithelial neoplasia under local anaesthesia in an outpatient setting. Seventy-seven patients, who underwent this procedure, were interviewed three months later concerning pain during treatment, pain and bleeding in the immediate postoperative period, and their general opinion about this procedure. The median duration of surgery was 11 minutes. The postoperative median observation time was 90 minutes. Seventy-one women experienced no discomfort during treatment. Thirty-one patients needed mild analgesics for an average of three days. Bleeding continued for a mean of 7.7 days after treatment and 73% experienced the bleeding as less, 8% as more as compared to menstrual bleeding. Ninety-two percent of the women would prefer this procedure if they had to undergo conization once again. In conclusion, we found a high acceptability in women treated with CO2 laser excisional conization under local anaesthesia in an outpatient setting.

Adult↗