Neoplasia cervical intraepitelial tipo III, poshisterectomía supracervical laparoscópica: ventajas e inconvenientes de la conservación del cuello uterino en pacientes histerectomizadas / Cervical intraepithelial neoplasia type III after laparoscopic supracervical hysterectomy. Advantages and disadvantages of cervical conservation in hysterectomized patients

Resumen ANTECEDENTES: Existen múltiples opciones para practicar una histerectomía: por vía vaginal, abdominal laparotómica, laparoscópica o robótica. En pacientes que van a intervenirse por enfermedad benigna puede hacerse mediante la extirpación del cuerpo uterino (histerectomía parcial o supracervical). La preocupación por la posible aparición de una lesión neoplásica en el muñón cervical remanente ha dado lugar a investigaciones acerca de las ventajas de la exéresis del cuello uterino (histerectomía total). CASO CLÍNICO: Paciente de 36 años, intervenida para histerectomía supracervical con salpingectomía bilateral laparoscópica, por útero miomatoso sintomático. Posterior a la cirugía apareció una lesión preneoplásica de alto grado; se le indicó conización cervical. CONCLUSIÓN: Algunos expertos advierten que los riesgos de extirpar el cuello uterino son lo suficientemente notables como para optar por la técnica parcial en pacientes sin antecedentes de patología cervical, sobre todo si tienen cuadros adherenciales o endometriosis del tabique rectovaginal. Por el contrario, otros grupos indican que ante la baja tasa de complicaciones de la histerectomía total y la posibilidad de una patología neoplásica posterior, no está justificada la preservación cervical.

Abstract BACKGROUND: There are multiple approaches to perform a hysterectomy; the classic vaginal route, the laparotomic abdominal or the newest endoscopic techniques, such as laparoscopic or robotic. In patients undergoing benign pathology, the technique can only be performed by removing the uterine body (subtotal or supracervical hysterectomy). However, the concern about the possible occurrence of a neoplastic lesion in the remaining cervical stump has led to investigations into the benefits of also performing the cervical exeresis (total hysterectomy). Our goal is to present a review on the current situation of the topic, concluding that there is still no scientific consensus on which technique is the most recommended. CLINICAL CASE: 36-year-old woman who underwent supracervical hysterectomy with laparoscopic bilateral salpinguectomy due to symptomatic myomatous uterus. After surgery, he presented a high-grade preneoplastic lesion, which indicated that cervical conization was indicated. CONCLUSION: Some experts argue that the risks of performing the removal of the cervix are notable enough to indicate subtotal technique in patients without a history of cervical pathology, especially if they have adhesion or endometriosis of the rectovaginal septum. On the contrary, other working groups indicate that cervical preservation is not justified due to the low complication rate of the total hysterectomy technique and the possibility of developing a subsequent neoplastic pathology.

Effects of dezocine or flurbiprofen combined with propofol-remifentanil in cervical precancerosis conization / 中国癌症杂志

Background and purpose: Cervical conization is a common operation to treat precancerous tissues performed under non-intubated anesthesia. As common opioid analgesics have side effects of inhibiting respiration and circulation, other kinds of analgesic drugs should be coordinated to improve the anesthetic effect, without interfering the respiration and circulation. This study aimed to evaluate the effects of dezocine or flurbiprofen combined with propofolremifentanil in cervical precancerosis conization. Methods: Sixty patients who underwent cervical conization were equally randomized into dezocine group (group D), flurbiprofen group (group F) and 0.9％ natural saline (group N) with 20 patients in each group, and received dezocine 0.1 mg/kg, flurbiprofen 1 mg/kg or 0.9％ natural saline in 5 mL respectively before anesthesia induction. During the anesthesia induction, the targeted control infusion of remifentanil in effect concentration was set at 1.5 ng/mL, and the plasma concentration of propofol was set at 2 μg/mL. Heart rate (HR), respiratory rate (RR), surplus pulse O2 (SPO2) and mean arterial pressure (MAP), MAP were monitored before the anesthesia induction (T0) and after (T1), at the start of cervical conization (T2), and at the end of operation (T3). The incidence of respiratory depression and body movements during surgery were observed. The satisfaction degree of the surgeon to the opening status of cervix was evaluated. The post-operative recovery time, visual analogue scale (VAS) scores, nausea and vomiting in the following 12 hours were also recorded. Results: The HR, RR, SPO2 and MAP in three groups did not have any significant change (P＞0.05) at T0, T1 and T3. At T2 the HR and MAP decreased significantly in group D and group F compared with group N (P＜0.05), and there was no significant difference between group D and group F (P＞0.05). The surgical satisfaction degree of "Good" in group D was 80％, significantly higher than that in group N (30％) and group F (50％), indicating a better cervix opening in group D. The recovery time in three groups had no significant difference, and the VAS scores in group D and group F were lower than those in group N (P＜0.05) after operation, and patients did not have nausea or vomiting in the following 12 hours. Conclusion: Both the dezocine and flurbiprofen could improve the anesthetic effect in cervical conization and post-operative comfort, with less respiratory or circulation depression. Dezocine showed better improvement than flurbiprofen in cervix opening and the inhibition of stress response and body movements during surgery.

The value of P16 immunohistochemical detection in judge residue of patients with conization in high grade intraepithelial neoplasia / 重庆医学

Objective To investigate the feasibility of P16 immunohistochemistry combined with routine pathology in judging the residual lesion of high grade cervical intraepithelial neoplasia.Methods Patients with cervical conization for high grade cervical intrapithelial neoplasia in this hospital from January 2014 to May 2016 were chose and divided into P16 immunohistochemical detection combined with pathological diagnosis group and pathological evaluation group according to patient's motivation.Patients with residual margins were treated in accordance with the clinical guidelines and TCT was followed up for 6 months after no margin.Then sensitivity and accuracy of two group were analyzed by gold standard of follow-up results.Results 104 patients in P16 immunohistochemical detection combined with pathological diagnosis group were negative in TCT test after 6 month of following up after surgery.However,at the time of 6 months follow-up after surgery,7 patients of 112 patients have been diagnosed with positive by TCT in pathological evaluation group.The Sensitivity and accuracy in P16 immunohistochemical detection combined with pathological diagnosis group were 100％ which were higher than pathological evaluation group.Conclusion P16 immunohistochemical detection combined with conventional pathology can accurately diagnose the cervical cutting edge of conization.

The expression and significance of TNF-α,IL-6, HMGB1 in the cervix uteri after the prior cervical conization / 重庆医学

Objective To investigate the dynamic changes and its significance of inflammatory factors in cervical secretions and prior cervical tissues after cervical conical resection.Methods Women who received prior cervical conization during December 2013 and December 2015 in this hospital were selected,then the cervical tissue and secretion were collected regular interval after the conization.The expression of tumor necrosis factor-α(TNF),interleukin 6 (IL-6) and high mobility group protein 1 (HMGB1) were quantitative detected and analyzed.The expression and infiltration of inflammatory cell were detected by HE and immunohistochemical staining.Results The expression of TNF-α,IL-6 and HMGB1 in cervical tissues and secretions increased gradually after priorcervical conization,which reached the peak at 1 to 2 weeks after priorcervical conization,and then gradually decreased,the differences were statistically significant when compared with the preoperative control group (P＜0.05).The inflammatory cell infiltration and the inflammatory response were most severe at 1st week after the conization.The expression of TNF-α,IL 6 and HMGB1 was at 1st week after the conization were significantly higher than that of the 4thweek group.Conclusion The cervical inflammatory were most severe after the prior cervical conization about 1-2weeks,and the hysterectomy should be avoided at this stage.

The prediction value of cone margin status for risk of residual focal in patients with cervical adenocarcinoma in situ / 中国基层医药

Objective To observe the clinical value of the cervical conization operation margin in predicting residual focal in patients with adenocarcinoma in situ (ACIS).Methods 60 ACIS patients were reviewed,and postoperative specimens were analyzed.Negative resection margin was defined as:no residual tumor epithelial cell was seen in operation margin around,and normal cervical epithelial cells can be visible.Relations between the margin status and incidence of residual were analyzed.Results The margin positive rate in LEEP was 56.8%,which was significantly higher than that in CKC(26.1 %,χ2 =5.390,P =0.02).The corrected odds was 4.31 (OD =4.31 , 95%CI 1 .1 3 -1 6.43,P =0.03).None had no residual tumor in 26 cases with margin negative,and 1 7 cases (65.4%)were detected with residual tumor in 26 positive margins (χ2 =25.257,P <0.01 ).Conclusion The ACIS patients with negative margins have a lower risk for residual focal.The standard sampling and judging methods in evaluating margin criteria can enhance the predictive value of margins.

The clinical significance of the second biopsy-cervical conization in the diagnosis and treatment of cervical lesions / 西安交通大学学报(医学版)

ABSTRACT:Objective To investigate the clinical value and application indications of the second biopsy-cervical conization in the diagnosis and treatment of cervical lesions.Methods We selected 413 patients from Department of Gynecology and Obstetrics,General Hospital of Jinan Military Command,who received cervical multi-point biopsy pathology IA for cervical cancer and cervical conization (LEEP knife)of the second biopsy between January 2012 and October 2015.Their data were retrospectively analyzed.Results Compared with cervical multi-point biopsy, the second biopsy-cervical conization after operation had pathological upgrade in 10.65% (44/413),agreement in 73.37% (303/413),and reverse (pathological levels drop and overcast)in 15.98%(66/413).Cervical multi-point biopsy and the second biopsy-cervical conization significantly differed in the diagnosis of cervical low-level intraepithelial lesion,high-grade intraepithelial lesions,and early invasive cancer (IA)(T=21.740,v=3-1=2,P<0.05).Before conization high-risk type HPV infection positive rate was 71.91%(297/413);after operation it was 86.36% (38/44)in upgrade pathology and 70.20% (259/369)in non-upgrade one.And thin prep cytologic test (TCT)showed that the positive rate (ASC-US and above)was about 87.89% (363/413), of which about 11.85% (43/363)was pathological upgrade after conization.The positive rates of high-risk type HPV infection and TCT result (ASC-US and above)in cervical lesions differed significantly between pathological upgrade and non-upgrade after conization (χ2=5.092,P<0.05,χ2=4.476,P<0.05).Conclusion The second biopsy-cervical conization technique as a means of reevaluation of cervical pathological changes in diagnosis and treatment of cervical biopsy under colposcopy can significantly improve diagnosis rate,reduce misdiagnosis and occult cervical cancer,but its clinical application has some indications.

The effect of cervical conization on the outcome of subsequent fertility and adverse pregnancy / 中国基层医药

Objective To evaluate the effect of cervical conization on the outcome of subsequent fertility and adverse pregnancy.Methods 87 cases of cervical intraepithelial neoplasia (CIN)patients cured by cervical coniza-tion were choosed as observation group.And randomly 90 cases women from pregnancy clinic were choosed as control group.the pregnancy outcomes were compared beween the two groups.Results The observation group:pregnancy rate was 88.5%(77 cases).The control group:pregnancy rate was 91.1%(82 cases)(P >0.05).The difference was not statistically significant.The observation group:premature rate was 14.9%(13 cases)and PROM rate was 17.2%(15 cases),which were higher than 6.7% and 8.9% in the control group.The differences were statistically significant (χ2 =3.45,3.04,all P <0.05).There was no significant difference in the abortion rate and cesarean section rate. (χ2 =0.02,0.15,all P <0.05)Conclusion Cervical conization has no obvious effect on the ability of pregnancy, abortion rate and cesarean section rate,but the premature rate and rate of premature rupture of membranes increase.

Risk factor analyses of positive margins of conization specimen and post-cone residual disease in patients with cervical intraepithelial neoplasia grade 3 / 医学研究生学报

[Abstract ] Objective Positive margins of conization specimen for cervical intraepithelial neoplasia grade (CIN)3 is a high risk factor of continuous cervical lesions or progress to early invasive carcinoma .The aim of this study was to evaluate the risk factors of positive margins of conization specimen and post-cone residual disease in hysterectomy specimens following conization for CIN 3. Methods Clinical data from 218 patients with CIN 3 underwent hysterectomy after conization from 2001 to 2013 were analyzed retro-spectivly.Multi-factors logistic regression was performed to determine the independent risk factors for positive margins of conization specimen and post-cone residual disease. Results Fifty five cases(25.2%) had positive margin of conization specimen , and the independent risk factors were unsatisfactory colposcopy (OR:5.18,95%CI:2.49-11.10), width of conization specimen smaller than 2 cm (OR:7.68,95%CI:2.31-28.10) and pathology of CIN3 with carcinoma in situ (OR:4.38,95%CI:1.67 -12.10).Forty seven patients (21.6%) had post-cone residual disease , and the independ-ent risk factors were length of conization specimen smaller than 1.5 cm (OR:2.45,95%CI:1.12-5.69), pathology of CIN3 with carci-noma in situ (OR:4.96,95%CI:2.17-11.70) and status of coniza-tion margins (OR:4.34,95%CI:1.95-9.78). Conclusion The satisfaction of colposcopic examination, conization specimen di-ameters including width and length , CIN3 with carcinoma in situ and status of conization margins could contribute to positive margins of conization or residual disease in subsequent hysterectomy specimens .More attention should be paid to such a group of CIN 3 patients clinically.

Pseudoaneurysm of uterine artery causing intra-abdominal and vaginal bleeding after cervical conization

Uterine arterial pseudoaneurysm is a very rare condition usually associated with postpartum hemorrhage. It almost never occurs after cervical conization; however, since ruptured pseudoaneurysm could be life threatening, we should consider the possibility of vascular injury such as pseudoaneurysm when we find a patient with vaginal bleeding after the process of surgical operation. Emergency arterial embolization is a well established therapeutic option to control the ruptured pseudoaneurysm. This is a case report of uterine arterial pseudoaneurysm causing intra-abdominal bleeding followed by cervical conization, which was successfully treated by uterine artery embolization.

¿Preservación de la fertilidad en cáncer de cérvix?: es possible

El cáncer de cérvix es la causa más común de muerte por cáncer ginecológico en el mundo. Debido al incremento del diagnóstico de esta enfermedad en estadios tempranos en mujeres en edad fértil, hacemos énfasis en los nuevos conceptos de preservación de la fertilidad y tratamiento quirúrgico mínimamente invasivo. El cono frío de cérvix con o sin linfadenectomía pélvica representa un esquema de tratamiento adecuado para el manejo de cáncer de cérvix en estadio IA1-2 en pacientes que desean conservar su fertilidad. Sin embargo, su potencial curativo no ha sido explorado extensamente en lo que concierne a la enfermedad en estadios IB1. En el Instituto Nacional de Enfermedades Neoplásicas (INEN), desde hace cinco años se ha iniciado el manejo individualizado de estas pacientes por la mayor demanda de pacientes jóvenes, quienes desean preservar la fertilidad, con el consentimiento informado de las pacientes y con resultados óptimos hasta la actualidad. Se presenta cuatro casos de cáncer de cérvix en estadios IA2 y IB1 con factores patológicos de riesgo bajo, en quienes se planteó cirugía conservadora para la preservación de la fertilidad. Se les realizó cono frío del cérvix y linfadenectomía pélvica bilateral laparoscópica. Los resultados demostraron que la cirugía conservadora en estadios tempranos de cáncer de cérvix de riesgo bajo es factible en mujeres jóvenes, logrando preservar su fertilidad, con las mismas tasas de curación que la cirugía radical.

Cervical cancer is the most frequent cause of death by gynecologic cancer in the world. Due to increased diagnosis of early stage disease in childbearing age women new concepts in fertility preservation and minimally invasive surgical treatment are emphasized. Cervical cold conization with or without pelvic lymphadenectomy is appropriate treatment for stage IA1-2 cervical cancer in patients who desire fertility. However curative potential has not been extensively explored concerning to IB1 stage disease. In the past five years individualized treatment of these patients has been started at Instituto Nacional de Enfermedades Neoplasicas (INEN) due to increased demand of young patients who wish to preserve fertility, with informed consent of patients and good current results. Four cases of stages IA2 y IB1 cervical cancer with low-risk pathology factors with conservative surgery for fertility preservation are presented. Cervical cold conization and bilateral laparoscopic pelvic lymphadenectomy was performed. Results demonstrated that conservative surgery in low risk early stages cervical cancer is feasible in young women, with fertility preservation and same cure rates as radical surgery.

Evaluation of cervical conization in diagnosis and treatment of cervical intraepithelial neoplasia and early cervical cancer / 中国医师进修杂志

Objective To determine the clinical value of cervical conization in diagnosis and treatment of cervical intraepithelial neoplasia(CIN)and early cervical Cancer.Methods The clinical data of 142 patients who underwent cervical conization and vaginoscope multiple biopsies were analyzed retrospectively,and the results and complications were compared.Results There was a correlation in pathology cervical conization and vaginoscope multiple biopsies in 70 cases(49.3%,70/142).The major complication of cervical conization was hemorrhage and cervix adherence.The percentage of cervix adherence was 2.8%(4/142).The blood volume200ml were 125,10,6 and 1 case respectively.Conclusions Cervical conization plays a very important role in diagnosis of CIN and early cervical cancer.It is simple,short time,little hemorrhage and high excision rate.

Procedimiento de escisión electro-quirúrgica por asa térmica y riesgo de parto prematuro: una revisión sistemática de la literatura / Loop electrosurgical excision procedure and risk of preterm delivery: a literature review

Antecedentes: A diferencia de la conización cervical por cono frío, no se ha podido demostrar una clara asociación entre el procedimiento de escisión electro-quirúrgica por asa térmica (LEEP) y el riesgo de parto prematuro. Objetivo: Análisis crítico de la literatura científica, en relación al riesgo de presentar un parto prematuro en pacientes que han sido sometidas a LEEP, y los resultados materno-perinatales asociados. Búsqueda sistemática en múltiples bases de datos. Resultados: Se encontraron sólo tres artículos que cumplían los criterios de inclusión, los cuales son incluidos en esta revisión. De éstos, el primero muestra que el LEEP no aumenta el riesgo de parto prematuro ni de recién nacidos de bajo peso. El segundo evidencia un aumento del riesgo de rotura prematura de membranas y parto prematuro secundario a esto, pero no de parto prematuro espontáneo. Sin embargo, el tercero, señala que el LEEP se asocia en forma significativa a riesgo aumentado de parto prematuro, parto prematuro secundario a rotura prematura de membranas y recién nacidos de bajo peso. Los tres estudios son de cohortes retrospectivas, lo cual les otorga un nivel de evidencia de tipo 2b. Conclusión: La evidencia indica que la excisión de la zona de transformación a través del uso de LEEP está asociada a un pequeño, pero real incremento del riesgo de presentar un parto de pretérmino.

Background: Unlike cold-knife conization, studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). Objective: Critical analysis of the literature to establish if the LEEP treatments increase risk of preterm delivery and its influence in maternal-perinatal results. Results: Only three studies were filling the inclusion criteria. The first study does not show that LEEP treatment increase risk of preterm delivery and low birth weight. The second study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, but not spontaneous preterm delivery. Nevertheless, the third study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, spontaneous preterm delivery and low birth weight. The three studies are based in retrospective cohorts, which grant them a level of evidence of type 2b. Conclusion: The evidence indicates that loop excision of the transformation zone by LEEP is associated with a small but real increase the risk of preterm delivery.

Conización leep en NIE de alto grado en una institución privada de salud / Leep conization for high degree intraepithelial neoplasias

Antecedentes: La conización cervical del cuello uterino es considerada el tratamiento de elección de las neoplasias intraepiteliales de alto grado. Objetivo: Analizar los resultados del tratamiento de esta patología mediante conización Leep. Método: Se revisan los antecedentes y biopsias de 145 pacientes con diagnóstico histológico de neoplasia intraepitelial II y III tratadas con conización cervical por asa Leep en la Unidad de Patología del Tracto Genital Inferior de Clínica Dávila desde el 1 de junio de 2002 al 31 de mayo de 2008. Resultados: Hubo una correlación colpo-biópsica de 80 por ciento (116/145) para Lie de alto grado. Hubo borde positivo en 75 pacientes (51,7 por ciento) y negativo en 70 (48,3 por ciento). Fue necesario un segundo tratamiento en 5 pacientes (3,4 por ciento); en 3 casos por recidivas y en 2 por lesiones invasoras. El 89 por ciento permanece en seguimiento, comprobándose que la totalidad de estas ha tenido un tratamiento considerado satisfactorio. Conclusión: Nuestros resultados confirman que las lesiones cervicales de alto grado deben ser tratadas por métodos escisionales preferentemente, siendo la conización con asa Leep el método de elección por su facilidad de realización, bajo costo de insumos y puede ser realizado sin grandes requerimientos de infraestructura.

Background: The cervical conización of the uterine cervix is considered the treatment of election of high degree intraepithelial neoplasias. Objective: To analyze the results of treatment of this pathology by Leep Conization. Method: The antecedents and biopsies of 145 patients with histological diagnosis of intraepithelial II and III neoplasia, treated with cervix Conization Leep at Lower Genital Tract Unit of Davila Clinic from June first 2002 to May 31 2008 are reviewed. Results: There was a colpo-biopsy correlation of 80 percent (116/145) for high degree CIN. There was positive edge in 75 patients (51.7 percent) and negative in 70 (48.3 percent). A second treatment in 5 patients were necessary (3.4 percent); in 3 cases by recurrences and 2 by invasive lesions. 89 percent remain in control, verifying itself that the totality of these has had a satisfactory considered treatment. Conclusion: Our results confirm that the high degree cervical lesions must preferably be treated by excision methods, being the Leep Conization the method of election by their facility of accomplishment, low cost and can be made without great infrastructure requirements.

LEEP conization on future obstetrics outcome / 中国综合临床

Objective To evaluate the implication of LEEP cervical conization on the outcome of subse-quent pregnancy. Methods The study group comprised 85 women who had a LEEP in Renmin Hoapital of Wuhan University during Jan. 2005 and Jan. 2007 ,and then had a subaequent pregnancy. 109 control women were extracted from outpatient clinic who received antenatal care in the same period with no history of cervical surgery, matching by age, health condition and perinatal stage. The pregnancy outcome of two groups were analyzed. Results Women who had a LEEP were more likely to give preterm delivery than controla (9.88% va 3.70%). But there waa no differ-ence in preterm delivery(χ2=2.97, P>0.05). So were low birth weight infants, preterm premature rupture of mem-branes (pPROM) or cesarean section. On a further study, we found that the time interval between cervical conization and subsequent pregnancy was associated with risk of preterm birth. The shorter time interval, especially shorter than 6 months,the higher risk of preterm birth. Conclusions LEEP cervical conization is not associated with an in-creased risk of preterm delivery, low birth weight infants, pPROM or cesarean section. LEEP conization is a more sol-id choice for women who want to preserve reproductive function. But it would be better for them to have pregnancy plan six months later.

The effects of cervical conization on sexual function / 대한산부인과학회지

OBJECTIVE: This study is aimed to evaluate the effects of cervical conization on sexual function in patients with non-malignant conditions. METHODS: We choose thirthy-one patients who were operated by cervical conization. They were interviewed retrospectically that effects on sexual desire or interest, sexual activity or frequency, pleasure, communication and satisfaction with sexual relationship. RESULTS: After cervical conization, there was no statistically significant change (p>.05) in sexual desire or interest, sexual activity or frequency, pleasure, communication and satisfaction with sexual relationship. CONCLUSION: Cervical conization was not found to have any adverse effects on sexual function in our study. In this respects, conization is a suitable conservative method when treating patients with non-malignant conditions.

Evalution of Cervical Conization in Dianosis and Management of Ceivical Carcinoma in Situ / 医学研究杂志

Objective To evaluate the clinical value of cervical conization in diagnosis and management of cervical carcinoma in situ.Methods The clinic-pathological data of the 65 patients with cervical carcinoma in situ from Jan 2004 to Feb 2007 were analyzed retrospectively.Results(1)Of the 65 patients,59 cases had received the colposcopical multiple biopsies before the cervical conization and there was a correlation in pathology between cervical conization and colposcopical multiple biopsies in 46 cases(78.0%),but there was not much correspondence between cervical conization and colposcopical multiple biopsy in 13 cases(22.0%).(2)30 patients were received hysterectomy or cervical conization again.Patients with positive margins were significantiy more likely to have residual disease than those with negative margins(P

Validity of frozen section in cervical conization.

Objective: To evaluate the validity of pathological diagnosis of cervical cone specimens prepared by frozen section compared with paraffin section. Study design: Diagnostic test evaluation. Setting: Pathology division, Department of Obstetrics and Gynecology, faculty of Medicine Siriraj Hospital, Mahidol University. Methods: Cervical cone specimens from 78 patients who underwent cold knife conization at Siriraj Hospital from October 1997 to September 1998 were processed by frozen section technique and the pathological diagnoses were made immediately. The remaining cone tissue from each specimen was processed to produce permanent paraffin sections for a final diagnosis. The frozen and permanent pathological diagnoses were compared. Results: The pathological diagnosis from frozen section was in complete agreement with the permanent section in 60.26% of patients. When the subjects were divided into three groups; normal and CIN I, CIN II-III and MIC and invasive cancer, the Kappa analysis for agreement of the pathological diagnoses between the two methods was 0.46 (fair agreement). For the diagnosis of invasive cancer by frozen section, the sensitivity, specificity, positive and negative predictive value, false negative and false positive were 62.5, 97, 71.4, 95.8, 37.5 and 1.9%, respectively. There were three cases of invasive cancer on permanent paraffin section which were diagnosed by frozen section as MIC in tow cases and CIN III in the other. Conclusion: Frozen section evaluation of a cervical cone specimen carries only a moderate degree of agreement with permanent paraffin section. For the diagnosis of invasive cancer in this study, frozen section has a low sensitivity and a high false negative rate. The diagnosis of microinvasive cancer was subject to significant error. The diagnosis of microinvasive cancer by frozen section needs additional careful review of the permanent section.

Experiences in Cervical Conization by Hysteroscopy for 1026 Patients with Benign Cervical Lesions / 中国微创外科杂志

Objective To investigate the clinical effectiveness of hysteroscopy in cervical conization for benign lesions. Methods A total of 1026 patients with benign cervical lesions were treated by cervical conization under a hysteroscope from January 2000 to December 2006. Results The operation time was 5-25 min and the intraoperative blood loss was 5-100 ml. The patients received re-examination 3 menstrual cycles after the operation. Among them, 990 patients were cured (cure rate,96.5%); the other 36 patients (34 improved and 2 ineffective) were cured after the second operation. No surgery related complications occurred. Conclusion Hysteroscopy is effective for cervical conization. The method is worth being widely used for fewer complications.

Post-cervical conization pap-smear examination.

Out of 68,240 slide of total Pap smears at Cytological Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, fron January 18, 1988 to October 31, 1989, 288 (0.4%) slides of Pap smears from post-cervical conization patients were examined. The median age was 32 years, the mean age was 35.5+10.5 years and the range of ages was between 19-73 years. They were carcinoma in situ (44.4%), severe dysplasia (6.3%), morderate dysplasia (4.5%) and normal (3.5%). Cytological diagnosis were normal (39.6%), infection and inflammation (39.6%), moderate dysplasia (4.2%), severe dysplasia (4.5%), carcinoma in situ (3.8%), non-keratinized squamous cell carcinoma (1.0%) and inadequate specimen (37.8%). Histological examination in abnormal Pap smears was 4.2% that had 1.7% of abnormal results (1 case of carcinoma in situ, 1 case of adenocarcinoma in situ, 1 case of atypical hyperplasia of endocervix and 2 case of severe dysplasia.