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.

Management of High Grade Cervical Intraepithelial Neoplasia Using CO2 Laser Conization and LEEP / 대한부인종양콜포스코피학회잡지

Between June 1990 and May 1994, 350 laser conization and 200 LEEP were performed. Indications of conization were that directed biopsy specimen was proved CIN II, III or suggests possible microinvasion. In all the cases the procedures were carried out with the patients under local anesthesia. Excisional cone sections(6,600) were evaluated for lesion length,depth and margin status. Invasive cancer was found in 5(1.4%) women of laser group. Operative time was shorter LEEP group than laser group significantly. In laser group, 25(8.3%) women had bleeding that required treatment. One case(0.3%) of pelvic infection and 7 cases(2.3%) of cervical stenosis were observed. In LEEP group, 10(5.3%) women had bleeding, 3(1.6%) patients became cervical stenosis. The diameter of bumed tissue was 0.28mm in laser group and 0.25mm in LEEP group. Success rate were 97.4% in former and 96.3% in later. This study demontrated that CO2 laser conization and LEEP were effective methods for treating high grade cervical intraepithelial neoplasia and added benefit of preserving reproductive function and rule out invasive carcinoma.