Neoplasia intraepitelial escamosa cervical de alto grau: abordagem ambulatorial / High-grade cervical intraepithelial neoplasia: outpatient approach

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

Células glandulares atípicas: abordagem ginecológica / Atypical glandular cells: gynecological approach

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)

Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)

Adenocarcinoma cervical in situ: abordagem na atenção primária e secundária à saúde / Cervical adenocarcinoma in situ: approach in primary and secondary health care

O adenocarcinoma cervical in situ é uma doença rara, totalmente curável, diagnosticada predominantemente por meio de rastreamento cervicouterino seguido de biópsia guiada por colposcopia e/ou conização. O tratamento em pacientes que desejam preservar a fertilidade pode ser realizado num contexto ambulatorial; aquelas com paridade definida deverão ser abordadas em nível terciário.(AU)

Cervical adenocarcinoma in situ is a rare, fully curable disease diagnosed predominantly through cervical-uterine screening followed by colposcopy-guided biopsy and/or conization. Treatment in patients wishing to preserve fertility may be performed in an outpatient setting; those with defined parity should be approached at the tertiary level.(AU)

Comparsion of pathological differences between cervical high-grade intraepithelial lesions positive resection surgical margin after cold knife conization and hysterectomy / 临床与实验病理学杂志

Purpose To compare the pathological differences between cervical high-grade intraepithelial lesions (CHGIL) positive resection surgical margin after cold knife conization and total hysterectomy,and to explore how to take further clinical treatment measures.Methods The pathologic results of 74 patients with CHGIL positive surgical margin after cold knife conization and hysterectomy were analyzed retrospectively.Results There was a correlation between positive cervical incision margin and residual uterine lesion (P ＜ 0.01).Age,menopause status,gland involvement did not related to residual uterine lesions(P ＞ 0.05).There was significant correlation between the lesion-related quadrant and the residual rate of uterine lesion (P ＜ 0.01).Conclusion Cold knife conization and hysterectomy are safe and effective treatments for CHGIL.However,for the positive resection surgical margin after cold knife conization cases,hysterectomy should be carefully chosen and may choose conservative treatment or re-cone cutting.

Clinical study on effect of Kangfuxin Fluid on preventing infection and hemorrhage after cold knife conization / 重庆医学

Objective To explore the effect of Kangfuxin Fluid by local infiltration for preventing the postoperative infection and hemorrhage after after cold knife conization (CKC) in the patients with grade Ⅲ cervical intraepithelial neoplasia (CIN).Methods Eighty cases of grade Ⅲ CIN treated by CKC in this hospital from January 2015 to December 2016 were selected and randomly divided into the control group and observation group,40 cases in each group.The observation group conduct the Kangfuxin Fluid infiltrated gauze for compression hemostasis after CKC,while the control group used the povidone iodine infiltrated gauze for conducting compression hemostasis.The short term complications (fever infection rate,vaginal bleeding time and cervical wound healing time) and long term complications(cervical adhesion/narrow,late bleeding) were observed and compared between the two groups.Results The incidence of postoperative fever infection,vaginal bleeding time,wound healing time and rate of cervical adhesion in the observation group were lower than those in the control group,and the differences were statistically significant (P＜0.05);the late bleeding occurrence rate had no statistical difference between the two groups(P＞0.05).Conclusion Kangfuxin Fluid can effectively prevent the complications such as wound infection after CKC,and has clinical application value.

Clinical Efficacy of Cold Knife Conization and Transcervical Resection of Cervical Lesionin the Treatment of Cervical Intraepithelial Neoplasia Ⅱ, Ⅲ / 实用妇产科杂志

Objective:To compare the clinical efficacy of cold knife conization and transcervical resection of cervical lesion in the treatment of cervical intraepithelial neoplasia(CIN) Ⅱ,Ⅲ.Methods:The clinical data of 62 patients with CIN Ⅱ,Ⅲ underwent cold knife conization(CKC group) and 114 underwent transcervical resection of cervical lesion(TCRC group)in Zhujiang Hospital Southern Medical University from Jan 1 st 2010 to Jun 1 st 2014 were collected.The patients' age,pregnant frequency,mean operative time,preoperative pathological grading,blood loss during the operation and after the operation,positive resected margin,cervical stenosis and recurrence were compared between the two groups.Results:There was no difference on the patients age,pregnant frequency and preoperative pathological grading between the two groups(P ＞ 0.05).The mean blood loss during the operation (14.16 ± 14.10 ml)and the mean hospital stays(5.73 ± 1.43 days)of CKC group were significantly different from those of TCRC group(29.80 ±20.55 ml,4.75 ±1.23 days) (P＜0.05).There was no statistical difference on the mean operation time,postoperative vaginal bleeding rate,rate of positive resected margin,cervical stenosis rate and recurrence rate between CKC group and TCRC group (33.15 ± 11.42 min vs 33.18 ±14.61 min,33.9％ vs 21.1％,3.2％ vs 5.3％,4.8％ vs 4.4％,4.8％ vs 3.5％,respectively) (P＞0.05).The concordance rate of pre-operation and post operation pathological results of CKC group and TCRC group was 74.2％ (46/62) and 72.8％ (83/114) respectively,both kappa values were ＜ 0.75.Conclusions;Both CKC and TCRCT are safe as well as effective in the treatment of high-grade cervical intraepithelial neoplasia.Compared with CKC,TCRC has the advantage of short hospital stay,while much intraoperative blood loss,which calls for intraoperative attention.

Cervical Intraepithelial Neoplasia Managed by Cold Knife Conization with Electrocautery Hemostasis by Hysteroscope: 193 Cases Analysis / 实用妇产科杂志

Objective:To evaluate the value of diagnosis and therapy of cold knife conization with electro-cautery hemostasis by hysteroscope in the treatment of ceNical intraepithelial neoplasia (CIN).Methods :A retrospective analysis of the clinical data was carried out in 193 cases with CIN underwent cold knife coniza-tion with electrocautery hemostasis by hysteroscope from January 2005 to November 2008, and all patients had pathological diagnosis under colposcopic biopsy.Results:The operative time was from 15 to 40 mi-nutes, and the blood loss dunng operation was from 5 to 25 milliliters.The coincidence rate of histopathology before and after conization was 67.88% in 131 cases.9 CIN Ⅲ patients had positive margins after opera-tion, owing to scab break off bleeding of cervical wound was encountered in 18 cases.No infection and cervi-cal adhesion or stenosis occurred.Conclusions :Cold knife conization with electrocautery hemostasis by hyst-eroscope is an effective diagnosis and treatment for CIN.

Pregnancy Outcomes after Conservative Treatment of Cervical Intraepithelial Lesions: Cold Knife Conization and Loop Electrosurgical Procedure / 대한주산의학회잡지

OBJECTIVE: In this study, we evaluated whether different methods of conization of the cervix were associated with an increased risk of adverse pregnancy outcomes in subsequent pregnancy. METHODS: A retrospective case-control study was conducted. The study group included women who had undergone cold knife conization (n=170) or a loop electrosurgical excision procedure (LEEP) (n=86) and then had subsequent singleton pregnancies. The control group (n=497) included women with no history of cervical surgery. The outcomes were spontaneous preterm delivery and various neonatal outcomes such as low birth weight (LBW) and perinatal mortality. RESULTS: Cold knife conization was associated with a significantly increased risk of preterm delivery less than 34 weeks (relative risk 4.9, 95% confidence interval 1.6-15.1), preterm delivery less than 28 weeks (7.6, 15-39.6), LBW (2.6, 1.2-5.8), and perinatal mortality (11.9, 1.3-107.6). LEEP was not associated with a increased risk of adverse pregnancy outcomes. CONCLUSION: Cold knife cone biopsy, but not LEEP of the cervix, is associated with an increased risk of preterm delivery less than 34 weeks of gestation and adverse neonatal outcomes. Clinicians counsel women appropriately before conservative treatment of cervical intraepithelial lesions.

Comparison of treatment of cervical lesion by use of cold knife conization, electric conizer or large loop / 부인종양

OBJECTIVE: The treatment of intraepithelial neoplasia and microinvasive cervical cancer ranges from local destruvtive methods to total hysterectomy. The conservative treatment has increased as more lesions are being detected in young women. METHODS: This study was designed to compare the 112 microinvasive cervical cancer treatment reliability, efficacy, and safety of cold knife conization (23), electric conizer (31), and largr loop (58). RESULTS: The mean age for cold cone, conizer, and LEEP were 41.1, 41.4, and 42.2 years old. The parity for cold cone, conizer and LEEP were 3.1, 2.1, and 2.7 siblings. Resection margine involved pathologic finding were 47.8%, 54.8%, and 74.1% (P<0.05). After hysterectomy, residual disease for cold cone, conizer and LEEP were 1, 24, and 30 cases CONCLUSION: The results suggest that LEEP is quicker, safer, and lower cost than cold knife conization for the management of cervical intraepithelial neoplasia and micro invasive cancer.

The Review of Cervical Conization For Twelve Years / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and management of cervical neoplasia. METHODS: Cold knife conization was performed in total 163 patients from January 1992 to December 2003. The results of PAP smear and colposcopy-directed biopsy were compared with the pathologic diagnosis of conization. And we evaluated the rate of positive margin and the presence of residual lesion. And then, we reviewed the pregnancy outcome after conization. RESULTS: The rate of agreement between PAP cytology and conization was 45.4%, and the rate of agreement between colposcopy-directed biopsy and conization was 65.6%. Hysterectomy was done in 102 patients (62.6%). The positive rate of resection margin was 19.6%. The incidence of residual lesion after conization was 31.2% in margin (+) and 1.4% in margin (-). We evaluated 7 cases of pregnancy after conization. CONCLUSION: Cervical conization as surgical treatment was effective in cervical neoplasia patients, especially young patients, with continuous follow-up.

Current Concepts of Cervical Conization / 대한산부인과학회지

Conization is defined as excision of a cone-shaped or cylindrical wedge from the cervix uteri that includes the transformation zone and all or a portion of the endocervical canal. It is used for the definitive diagnosis of squamous or glandular intraepithelial lesions, for excluding microinvasive carcinomas, and for conservative treatment of cervical intraepithelial neoplasia (CIN). Techniques for diagnostic and therapeutic conization are virtually identical. The extent of excision must be adjusted according to individual needs. Conization can be performed with a scalpel (cold-knife conization), laser, or electrosurgical loop. The latter is called the loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ). Combined conization usually refers to a procedure started with a laser and completed with a cold-knife technique. Laser conization can be excisional or destructive (by vaporization). Each of these approaches has distinct benefits and disadvantages. Cold-knife conization provides the cleanest specimen margins for further histologic study, but it is typically associated with more bleeding than laser or LEEP, and it requires general anesthesia in most cases. Laser procedures are of longer duration and, especially if low-power density is used, may "burn" the margins, thus interfering with histological diagnosis. The main advantage with this procedure is that dots produced by the laser energy can be used to accurately outline the exocervical margins. However, overall, the benefit of using laser for conization may not justify the high cost of the procedure. LEEP procedures have several advantages, including rapidity, preservation of the margins for histological evaluation, and virtual bloodlessness. Moreover, one can perform LEEP procedures in the office or in other outpatient settings.

Complications of Sturmdorf's suture in cold knife conization / 대한산부인과학회잡지

OBJECTIVE: It has been recognized that cold knife conization has higher incidence of postoperative hemorrhage and many techniques have been developed in an attempt to control hemorrhage. The aim of this study was to evaluate complications of Sturmdorf's suture in cold knife conization and to investigate various measures employed to reduce blood loss. METHODS: The results of 85 patients who had cold knife conization for diagnosis or treatment of cervical intraepithelial neoplasia (CIN) from August, 1997 to July, 2003 were reviewed. RESULTS: Among 85 patients, 83 patients (97.7%) had negative cut margins on conization specimen while 2 patients (2.3%) positive cut margins. 54 patients received no further treatment after cold knife conization and complications occurred in 9 patients (16.7%). Postoperative hemorrhage requiring additional hemostatic procedures occurred in 7 patients (13%), of which 6 patients were rehospitalized and 1 patient was managed at outpatient clinic with gauze packing only. Among 6 rehospitalized patients, hysterectomy was done in 2 patients and electrocoagulation in 1 patient. Packed red cell was transfused in 1 patient and 2 patients were managed with gauze packing only. Postoperative infection was found in 2 patients (3.7%). No other significant complications were noted. CONCLUSION: Cold knife conization using Sturmdorf's suture could be done to get much more accurate results of biopsy with relatively mild complication in magement of CIN, although several days? admission is needed and the other alternative methods seem to be more convenient.

The Role of Cold Knife Conization in Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and treatment of cervical neoplasia. METHODS: Sixty patients were divided into diagnostic and therapeutic conization group and then indication of conization, PAP smear, colposcopy directed biopsy, cone margin and residual lesion of each group were compared respectively. RESULTS: If the difference of PAP and colposcopy directed biopsy was 2 grades or more, upper limit of the lesion was invisible, squamocolumnar junction was not seen, PAP V or invasive cancer was suspected, diagnostic conization was performed in 22 patients. Six cases of follow-up group had cone margin (-) and no recurrence. Sixteen cases of immediate TAH (total abdominal hysterectomy) group had 2 cases of cone margin (+) with residual disease. There were 4 cases of cone margin (-) with residual lesion. If the difference of PAP and colposcopy directed biopsy was 1 grade or less, upper limit of the lesion was visible, squamocolumnar junction was seen and invasive cancer was ruled out, therapeutic conization was performed in 38 cases. All of therapeutic conization group had cone margin (-). Thirty two cases were follow up group and six cases were immediate TAH group. Three of follow up group had recurrences and delayed TAH was performed. There was no residual lesion in the specimen of immediate TAH group. CONCLUSION: The precise dignosis and treatment of cervical neoplasia was capable with cold knife conization. The more aggressive lesion or the more cases of cone margin (+) was diagnosed, the more residual lesion was found. Thorough follow up should be done after treatment of cervical neoplasia because of the possibility of residual disease even after documentation of cone margin (-).

Effects of Cervical Physical Therapy and Excisional Therapy on the Prognosis of Cervical Precancerous Lesions / 中国微创外科杂志

Objective To investigate the prognosis of cervical intraepithelial neoplasia (CIN) Ⅱ and Ⅲ after being treated by microwave coagulation, loop electrosurgical excision procedure (LEEP) and cold knife conization. Methods From March 2000 to February 2006, 289 patients with CIN Ⅱ or Ⅲ diagnosed by colposcopic biopsy were treated and followed up according to consensus guidelines for the management of women with CIN. Results Totally 233 of the 289 patients (80.6%) completed the follow-up (3-56 months with a mean of 11.8). Among them, 77.7% (181/233) received treatment; the other 22.3% (52/233) did not. In the 181 patients who received treatment, the lesion disappeared in 160 (88.4%) cases, during the follow-up; while in those who did not received treatment, the CIN was cured spontaneously in 63.5% (33/52; ?2=17.664, P=0.000). The prognosis of CIN Ⅱ was similar among the patients who were treated with microwave coagulation, LEEP, or cold knife conization (?2=0.008,P=0.996). In addition, in the patients with CIN Ⅲ, the prognosis after cold knife conization was not significantly different from that after LEEP (?2=0.017,P=0.897). Conclusions The management of CIN Ⅱ and Ⅲ may increase the cure rate. However, the three therapeutic methods produce similar prognosis.