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Escamilla Galindo EP, Medina Ramos NF, Santana Mateo YL, Armas Roca M, Molero Sala L, León Arencibia L, Arencibia Sánchez O, Martín Martínez AI. Post-Conization FIGO stage IA1 squamous cell cervical carcinoma; is hysterectomy necessary? Eur J Obstet Gynecol Reprod Biol 2021; 264:368-373. [PMID: 34399105 DOI: 10.1016/j.ejogrb.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare and evaluate the results and suitability of two different approaches to the treatment of post-conization International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 cervical carcinoma: a more radical approach, directly scheduling a second surgery versus a more conservative one, which consists of performing a cotest (PAP plus HPV-test) in a follow-up visit and deciding whether to apply a second surgery on the basis of the results. STUDY DESIGN Retrospective descriptive study including 144 cases of stage IA1 cervical carcinoma diagnosed after a loop electrosurgical excisional procedure (conization), between 1987 and 2019 in the Mother-and-Child University Hospital of Gran Canaria (Spain). Selected patients were split into two groups for analysis: patients directly undergoing a second surgical intervention (hysterectomy or re-conization) after diagnosis and patients who were followed-up before making a decision whether to schedule a second surgery or continue to follow-up. RESULTS 75% of women directly receiving a second surgical intervention (no post-conization follow-up) underwent hysterectomy, while 25% underwent re-conization. Histological outcomes from hysterectomized patients showed 65% negative results for intraepithelial lesions, 9% low-grade squamous intraepithelial lesions (LSIL), 16% high-grade squamous intraepithelial lesions (HSIL) and only 10.5% confirmed invasive lesions: hysterectomy complication rate was 7%. Histological studies from women subjected to re-conization showed 32% negative results, 37% LSIL, 5% HSIL and 26% malignancy. In the group of patients who were followed-up after diagnosis, 8.8% needed a second intervention; none of them showed negative histological results, while 100% hysterectomized and 25% patients with re-conization showed HSIL. No unnecessary hysterectomy procedures were conducted in this group. HPV-16 was the most common genotype in both groups. CONCLUSION Conization proved to be a suitable alternative to hysterectomy as a treatment for post-conization stage IA1 cervical cancer. Our results showed that 65% hysterectomy procedures conducted without previously monitoring for residual disease corresponded to negative results and were therefore, unnecessary. We conclude that confirmation of the presence of residual disease by using cotest is essential to make a decision on further treatment and that a conservative management is often possible and, in our opinion, preferable.
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Affiliation(s)
- Esther Patricia Escamilla Galindo
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Norberto Fidel Medina Ramos
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Yaned Lourdes Santana Mateo
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Marta Armas Roca
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Laura Molero Sala
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Laureano León Arencibia
- Department of Pathology, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Octavio Arencibia Sánchez
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Alicia Inmaculada Martín Martínez
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
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Zhang Q, Li W, Kanis MJ, Qi G, Li M, Yang X, Kong B. Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 2018; 8:46580-46592. [PMID: 28418849 PMCID: PMC5542294 DOI: 10.18632/oncotarget.16233] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy. STUDY DESIGN This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity. RESULTS Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%). CONCLUSION Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.
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Affiliation(s)
- Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Wenhui Li
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Margaux J Kanis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Minghao Li
- Shandong University School of Medicine, Ji'nan, Shandong, P.R. China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
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Kardakis S. Fertility-preserving surgery in patients with early stage cervical carcinoma. ISRN ONCOLOGY 2012; 2012:817065. [PMID: 23320192 PMCID: PMC3539444 DOI: 10.5402/2012/817065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/30/2012] [Indexed: 11/23/2022]
Abstract
Fertility preservation is an important issue for patients in reproductive age with early stage cervical cancer. In view of recent developments, our purpose was to review and discuss available surgical alternatives. A literature search was conducted using PUBMED, including papers between 1980 and December 2011. In patients with stage IA1 cervical cancer, conization is a valid alternative. Patients with stage IA2-IB1 disease can be conservatively treated by radical trachelectomy. This is as well-established conservative approach and appears to be safe and effective in allowing a high chance of conception. Prematurity is the most serious issue in pregnancies following trachelectomy. Less invasive options such as simple trachelectomy or conization seem to be feasible for stages IA2-IB1, but more and better evidence is needed. Neoadjuvant therapy might allow conservative surgery to be performed also in patients with more extensive lesions. Ovarian transposition is important when adjuvant radiation is needed. In conclusion, available literature shows that there are interesting fertility-sparing treatment alternatives to the “golden standard” for the management of early cervical cancer in young women.
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Affiliation(s)
- Spyridon Kardakis
- Department of Obstetrics and Gynaecology, Oncologic Clinic, Västerås Hospital, 72212 Västerås, Sweden
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Ware RA, van Nagell JR. Radical hysterectomy with pelvic lymphadenectomy: indications, technique, and complications. Obstet Gynecol Int 2010; 2010:587610. [PMID: 20871657 PMCID: PMC2939408 DOI: 10.1155/2010/587610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/11/2010] [Indexed: 12/03/2022] Open
Abstract
Radical hysterectomy with pelvic lymphadenectomy remains the treatment of choice for women with Stages IA(2) and IB(1) carcinoma of the cervix, and selected patients with Stage II endometrial cancer. Improvement in surgical techniqe, administration of prophylactic antibiotics, thromboemolic prophylaxis, and advances in critical care medicine have resulted in lower operative morbidity associated with this procedure. Major urinary tract complications such as ureteral injury or vesico-vaginal fistula are now extremely rare (<1%). Five-year survival rates following this procedure vary according to a number of clinical and histologic variables, and may be as high as 90% in women without lymph node metastases.
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Affiliation(s)
- Rachel A. Ware
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA
| | - John R. van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA
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Fertility-conserving surgery for young women with stage IA1 cervical cancer: safety and access. Obstet Gynecol 2010; 115:585-590. [PMID: 20177290 DOI: 10.1097/aog.0b013e3181d06b68] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To estimate the safety of fertility-conserving surgery for stage IA1 cervical cancer and to analyze predictors of access to conization. METHODS We analyzed women with stage IA1 cervical cancer aged 40 years or younger who were diagnosed between 1988 and 2005 and recorded in the Surveillance, Epidemiology, and End Results database. The outcomes of hysterectomy were compared with fertility-conserving conization. Clinical and demographic characteristics were compared using chi2. Multivariable logistic regression models were constructed to examine predictors of conization. Survival was examined using multivariable Cox proportional hazards models and the Kaplan-Meier method. RESULTS A total of 1,409 patients were identified, including 841 (60%) who underwent hysterectomy and 568 (40%) who underwent conization. In a multivariable logistic regression of factors associated with conization, Asian patients, single women, those diagnosed in the later years of the study, and those residing in the eastern United States were more likely to have fertility-conserving surgery. Compared with women younger than 30 years, those older than 35 years were 78% (odds ratio 0.22, 95% confidence interval [CI] 0.16-0.30) less likely to undergo conization. In a Cox proportional hazards model accounting for other prognostic variables, there was no difference in survival (hazard ratio 0.65, 95% CI 0.23-1.47) between conization and hysterectomy. Five-year survival for women who underwent conization was 98% (95% CI 96-99%), compared with 99% (95% CI 97-99%) for those treated with hysterectomy. CONCLUSION Fertility-conserving surgery is safe for young women with stage IA1 squamous cell carcinoma of the cervix. Young women with microinvasive cervical tumors should weigh the risks and benefits of conization in the context of individual preferences and tumor characteristics.
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Lee SJ, Kim WY, Lee JW, Kim HS, Choi YL, Ahn GH, Lee JH, Kim BG, Bae DS. Conization Using Electrosurgical Conization and Cold Coagulation for International Federation of Gynecology and Obstetrics Stage IA1 Squamous Cell Carcinomas of the Uterine Cervix. Int J Gynecol Cancer 2009; 19:407-11. [DOI: 10.1111/igc.0b013e3181a1a297] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective:This study was performed to evaluate the efficacy and feasibility of electrosurgical conization and cold coagulation as definitive treatments for patients with International Federation of Gynecology and Obstetrics stage IA1 squamous cell carcinoma of the cervix and a resection margin free from (micro)invasive carcinoma after conization.Methods:Patients with stage IA1 cervical squamous cell carcinoma without lymphovascular space invasion who had been treated by electrosurgical conization and cold coagulation and who wanted to preserve fertility (or only undertake conservative treatment) were followed up without further surgical intervention. Patients with invasive or microinvasive carcinoma at resection margins or positive endocervical resection margins were excluded from the study. Cervicovaginal smears and colposcopic examination were performed at regular intervals. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia 2 or higher-grade lesions.Results:A total of 85 patients enrolled were deemed eligible to be involved in the study. The median follow-up period was 81.0 months (range, 13-127 months). Nineteen of the 85 patients had exocervical resection margins. There was one case of recurrence, which was node-positive invasive cancer recurrence (1.2%, 1/85), in patients with negative resection margins.Conclusions:These results suggest that electrosurgical conization with cold coagulation is a feasible treatment and could be used as a definitive therapy for patients with stage IA1 cervical squamous cell carcinoma without lymphovascular space invasion. In addition, patients having cervical intraepithelial neoplasias 2 and 3 at exocervical resection margins could be followed up carefully without further treatment after conization and cold coagulation.
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Pahisa J, Alonso I, Torné A. Vaginal approaches to fertility-sparing surgery in invasive cervical cancer. Gynecol Oncol 2008; 110:S29-32. [DOI: 10.1016/j.ygyno.2008.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
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Benedetti Panici P, Palaia I, Basile S, Perniola G, Sansone M, Gradinaru N, Zullo MA, Angioli R. Conservative approaches in early stages of cervical cancer. Gynecol Oncol 2007; 107:S13-5. [PMID: 17727934 DOI: 10.1016/j.ygyno.2007.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/19/2022]
Abstract
Several authors have proposed the use of a less aggressive surgery (i.e. conization, trachelectomy plus laparoscopic lymphadenectomy, modified or type 2 radical hysterectomy) for patients affected by early stages invasive cervical carcinoma. Tumor size and pelvic nodal status are parameters that must be evaluated to better select a patient's population suitable of a less aggressive surgery, with the aim of sparing morbidity without jeopardizing cancer cure.
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Affiliation(s)
- Pierluigi Benedetti Panici
- Institute of Gynecology, Perinatology and Child Health, La Sapienza University, Viale del Policlinico, 155, 00100 Rome, Italy.
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Dedes KJ, Dedes M, Varga Z, Zimmermann DR, Fink D, Fehr MK. Curative treatment of a pelvic side wall recurrence after conization for microinvasive cervical cancer stage IA1: a case report and review of the literature. J Low Genit Tract Dis 2007; 11:177-81. [PMID: 17596764 DOI: 10.1097/lgt.0b013e3180316720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients wishing to preserve fertility conization is regarded as an adequate treatment in cervical cancer stage IA1 without lymphovascular space involvement (LVSI). Reviewing case series with IA1 cervical cancers without LVSI, lymph node metastasis (LNM) is present in 0.5%. MATERIALS AND METHODS We pr esent a case of a 34-year-old patient treated with conization for squamous cervical cancer invading 1.2 mm without LVSI and horizontal extension of 6 mm (IA1). RESULTS At a routine postpartum examination after an uneventful pregnancy, a 5-cm pelvic mass was noted at the right pelvic wall. Intraoperative evaluation revealed a LNM which was resected, and postoperative pelvic chemoradiotherapy was performed. The patient remains recurrence-free 84 months after conization and 73 months after resection of the recurrence. CONCLUSIONS Occurrence of LNM in IA1 cervical cancers is very rare, but if early diagnosed curative treatment is possible.
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Affiliation(s)
- Konstantin J Dedes
- Division of Gynecology, Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich, Switzerland
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Abstract
Due to deficiencies of clinical staging, magnetic resonance (MR) imaging is being increasingly used in the pre-treatment work-up of cervical cancer. Lymph node status, as evaluated by advanced imaging modalities, is also being incorporated into management algorithms. Familiarity with MR imaging features will lead to more accurate staging of cervical cancer. Awareness of impact of staging on management will enable the radiologists to tailor the report to clinically and surgically relevant information. This article emphasizes the guidelines on the MR staging criteria, dependence of newer treatments on imaging staging and lymph node involvement, and MR imaging in post-treatment surveillance of cervical cancer.
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Affiliation(s)
- Khashayar Rafat Zand
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada; Synarc Inc, San Francisco, CA, USA; Body Imaging, McGill University Health Center, Montreal, QC, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada; Synarc Inc, San Francisco, CA, USA; Body Imaging, McGill University Health Center, Montreal, QC, Canada
| | - Hisashi Abe
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada; Synarc Inc, San Francisco, CA, USA; Body Imaging, McGill University Health Center, Montreal, QC, Canada
| | - Sharad Maheshwari
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada; Synarc Inc, San Francisco, CA, USA; Body Imaging, McGill University Health Center, Montreal, QC, Canada
| | - Ahmed Mohamed
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada; Synarc Inc, San Francisco, CA, USA; Body Imaging, McGill University Health Center, Montreal, QC, Canada
| | - Daniel Upegui
- Department of Radiology, McGill University Health Center, Montreal, QC, Canada; Synarc Inc, San Francisco, CA, USA; Body Imaging, McGill University Health Center, Montreal, QC, Canada
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Bafghi A, Castaigne D, Pomel C. Trachélectomie élargie : de la laparoscopie à la voie vaginale. ACTA ACUST UNITED AC 2006; 35:696-701. [PMID: 17088771 DOI: 10.1016/s0368-2315(06)76466-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report our experience of laparoscopic and vaginal radical trachelectomies. MATERIAL AND METHODS Between February 2001 and May 2005, 10 patients met the requirements for a trachelectomy: 6 for a laparoscopic procedure, 4 for a vaginal procedure. In the laparoscopic procedure, coagulation of the uterine artery had to be performed in 2 patients whereas in the vaginal approach, it was always possible to conserve it. RESULTS Mean age was 30 years. Median follow-up time was 25 months. Five patients were grade Ia2 and five were grade Ib1. One patient presented numerous lymphatic emboli and underwent radiation and chemotherapy. She died of a peritoneal progression of the disease. One had her baby with a scheduled C-section. One had a spontaneous miscarriage at 7 weeks. CONCLUSION The radical trachelectomy technique as described by Professor Dargent relies on the selective ligature of the cervico vaginal arteries and the necessity to preserve the uterine arteries. In our experience and that of others reported in the literature, the laparoscopic approach does not always permit to conserve them. In our opinion, the vaginal approach constitutes the best option.
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Affiliation(s)
- A Bafghi
- Service de Chirurgie Gynécologie, Institut Gustave-Roussy, 39, rue, Camille-Desmoulins 94800 Villejuif.
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Klaritsch P, Reich O, Giuliani A, Tamussino K, Haas J, Winter R. Delivery outcome after cold-knife conization of the uterine cervix. Gynecol Oncol 2006; 103:604-7. [PMID: 16750257 DOI: 10.1016/j.ygyno.2006.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 04/01/2006] [Accepted: 04/11/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To estimate the risk for preterm delivery and obstetric complications in women with prior cold-knife conization. METHODS In a retrospective study, we compared 76 deliveries of 65 women with prior cold-knife conization with the remaining 29,711 singleton deliveries at our institution between 1992 and 2002. RESULTS We found significant shorter duration of pregnancies in the conization group. Delivery prior to 37 weeks was found in 22.4% (n = 17) of the conization group and in 6.6% (n = 1961) of the controls (OR = 4.07 [2.22-7.10], P < 0.001). Preterm premature rupture of the membranes was found in 17.1% (n = 13) of the conization group and in 2.6% (n = 775) of the controls (OR = 7.70 [3.87-14.21], P < 0.001). Birth weight less than 2500 g was found in 18.4% (n = 14) of the conization group and in 7.7% (n = 2280) of the controls (OR = 2.72 [1.40-4.92], P = 0.002). Overall, birth weight in the conization group was not significantly lower (median 3147 g vs. 3287 g, P = 0.115). Cervical tears were found more frequently in the conization group (8.8% [n = 6] vs. 1.3% [n = 236], OR = 7.53 [2.63-17.57], P < 0.001). There was no difference in mode of delivery, duration of labor, head circumference, chorioamnionitis and use of oxytocin. CONCLUSION Cold-knife conization is a risk factor for preterm birth and preterm premature rupture of the membranes and seems to be a risk factor for cervical tears.
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Affiliation(s)
- Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz, Austria.
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Al-Nafussi A. Histopathological challenges in assessing invasion in squamous, glandular neoplasia of the cervix. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cdip.2006.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tseng CJ, Chang CC, Tseng CC, Hou HC, Wang CB, Chen CH, Soong YK, Pao CC. Loop conization for the treatment of microinvasive carcinoma of the cervix. Int J Gynecol Cancer 2006; 16:1574-8. [PMID: 16884368 DOI: 10.1111/j.1525-1438.2006.00358.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of the study was to evaluate the specimen adequacy and diagnostic accuracy of loop conization in microinvasive carcinoma of the cervix. A retrospective study was conducted from 1997 to 2003 at the Colposcopic Clinic, Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Taipei, Taiwan. Sixty-three consecutive patients with microinvasive carcinoma of the cervix receiving cold-knife conization (35 patients) or loop conization (28 patients) were included in the study. All patients underwent definitive hysterectomy. We reviewed the conization specimen together with the hysterectomied uterus to compare the two conization techniques with respect to the histopathologic interpretation and diagnostic accuracy. The mean depth of cone specimens was significantly less in the loop conization compared with cold-knife conization (1.65 versus 2.35 cm, P = 0.035). Regarding the application of conization, the loop conization was completed in a single slice in 27 patients (77.1%) and in multiple slices in 8 patients (22.9 %), in spite of encouragement to perform conization in a one-pass application when possible. However, the cold-knife specimens were invariably a single cone-shaped piece. As reviewed by microscopic examination, the rate of tissue transection was significantly higher in the loop group than in the cold-knife group (14.3% versus 0%, P = 0.04). Because of tissue transection and disorientation, pathologic evaluation of stromal status was inadequate in 11.4% (4/35) of the loop cones as opposed to none of the 28 cold-knife cones. After assessing the hysterectomy specimens, the clinical diagnoses in the loop group were downgraded in three patients compared with only one in the cold-knife group. Data from this investigation suggest that cervical cold-knife conization is superior to loop conization as a method to assess microinvasive cervical cancer.
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Affiliation(s)
- C-J Tseng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Abstract
Worldwide, cervical cancer is the second most common malignancy in women and a major cause of morbidity and mortality. Until recently, the greatest strides in reducing cervical cancer mortality have occurred with the advent and implementation of screening programs. Many important advances have also taken place in the diagnosis and treatment of cervical cancer. This review article will highlight diagnostic and staging considerations with an emphasis on newer imaging modalities and how they might augment approved FIGO clinical staging. Management alternatives for patients with early-stage disease, locally advanced (stage IIB-IVA) disease, and metastatic cervical cancer will be discussed. Whenever possible, these discussions will unfold through an overview of pertinent clinical trials and current controversies.
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Affiliation(s)
- David H Moore
- Department of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Raspagliesi F, Ditto A, Quattrone P, Solima E, Fontanelli R, Dousias V, Kusamura S, Carcangiu ML. Prognostic factors in microinvasive cervical squamous cell cancer: long-term results. Int J Gynecol Cancer 2005; 15:88-93. [PMID: 15670302 DOI: 10.1111/j.1048-891x.2005.15009.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We examined tumor-related pathologic factors and cone-related characteristics to identify parameters related to recurrence in microinvasive squamous cell carcinoma of the cervix treated with conization. This is a retrospective study on 67 consecutive cases of microinvasive carcinoma of the cervix [depth of invasion (DI) < 3 mm] treated with conization. The mean follow-up was 121 months (range 72-276 months). Four (6%) invasive recurrences were observed. Presence of lymphvascular space involvement (LVSI) was significantly related with recurrences (P < 0.05). The mean distance between tumor margin and apex of the cone (apical clearance) was 10.6 mm (range 5-22 mm), and the mean distance between lateral border of the cone and tumor margin (lateral clearance) was 6.5 mm (range 1.7-15 mm). We adopted cut-off values of 10 and 8 mm for apical and lateral clearances, respectively. We found a statistically significant difference between apical clearance and recurrence rate (P < 0.02). The LVSI was, other than DI, an important prognostic factor. Apical clearance was significantly correlated with recurrence. The cone-related characteristics, other than tumor-related pathologic factors, could help the decision concerning the definitive therapy for microinvasive carcinoma of the cervix.
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Affiliation(s)
- F Raspagliesi
- Department of Gynecology/Oncology, Istituto per lo Studio e la Cura dei Tumori, Via Venezian 1, 20133 Milan, Italy.
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Argenta PA, Kubicek GJ, Dusenberry KE, Judson PL, Downs LS, Carson LF, Boente MP. Widespread lymph node metastases in a young woman with FIGO stage IA1 squamous cervical cancer. Gynecol Oncol 2005; 97:659-61. [PMID: 15863175 DOI: 10.1016/j.ygyno.2004.11.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 11/24/2004] [Accepted: 11/26/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lymphatic and hematologic metastases are rare in microinvasive cervical cancers (FIGO stage IA1), supporting a role for conservative treatment. Cervical conization followed by prolonged surveillance is an accepted treatment in patients with low-risk features and negative surgical margins. This option is particularly appealing for younger or nulliparous patients, in whom fertility may be highly desired. CASE We report a case of a 22-year-old, HIV-negative female with stage IA1 squamous cell cervical carcinoma who was found to have bilateral lymph node metastases in both pelvic and para-aortic distributions after electing to undergo hysterectomy. CONCLUSION Clinicians treating patients with microinvasive cervical cancer conservatively must be aware of the possibility of lymph node involvement and should consider radiological imaging to look for metastatic disease.
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Affiliation(s)
- Peter A Argenta
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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Eisenkop SM, Spirtos NM, Lin WM, Felix J. Laparoscopic modified radical hysterectomy: a strategy for a clinical dilemma. Gynecol Oncol 2005; 96:484-9. [PMID: 15661239 DOI: 10.1016/j.ygyno.2004.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the role of laparoscopic modified radical (type 2) hysterectomy when cervical cancer cannot be excluded or documented preoperatively. METHODS Between 1996 and 2004, 50 patients with cervical intraepithelial neoplasia (CIN III) or adenocarcinoma in situ (AIS) involvement of cone endocervical margins and/or endocervical curettings, who were not candidates for observation or repeat conization, underwent laparoscopy to perform a modified radical hysterectomy. RESULTS Forty-nine (98.0%) modified radical hysterectomies were completed laparoscopically and one (2.0%) patient required a laparotomy. Of the overall group, 35 (70.0%) had residual pathology; 26 (52.0%) were precancerous lesions, and 9 (18.0%) had invasive disease (5 adenocarcinomas, 3 squamous lesions, and 1 adenosquamous carcinoma). Of the nine with cancer, one had stage IA1 disease, three had stage IA2 disease, and five had stage IB1 disease. Five (55.6%) invasive lesions were diagnosed intraoperatively (frozen section), and a laparoscopic pelvic and lower aortic lymph node dissection was performed. The median operative time was 96 min (range 58-185), blood loss 100 ml (50-450), and postoperative hospital stay 2.5 days (range 1-14). There were no incidences of prolonged urinary retention fistulas, or other serious complications. All patients with cancer remain disease-free (median follow-up 44.2 months, range 1-88.7 months). CONCLUSIONS Laparoscopic modified radical hysterectomy is a treatment option for patients for whom cervical cancer cannot be definitively excluded, and can be completed with acceptable operative time, blood loss, and hospitalization.
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Affiliation(s)
- Scott M Eisenkop
- Women's Cancer Center, Encino-Tarzana, 5525 Etiwanda Avenue, Suite 311, Tarzana, CA 91356, USA.
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Diakomanolis E, Haidopoulos D, Rodolakis A, Vlachos G, Stefanidis K, Komisopoulos K, Michalas S. Laser CO(2) conization: a safe mode of treating conservatively microinvasive carcinoma of the uterine cervix. Eur J Obstet Gynecol Reprod Biol 2004; 113:229-33. [PMID: 15063966 DOI: 10.1016/j.ejogrb.2003.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2002] [Revised: 03/04/2003] [Accepted: 06/12/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the outcome of conservative treatment by laser CO(2) conization, for the management of microinvasive carcinoma of the uterine cervix (MIC). STUDY DESIGN From 1990 to 1999, 90 women with the diagnosis of MIC were treated in the Gynecological Oncology Unit of "Alexandra" Hospital. Final diagnosis of MIC was based on cervical conization as well as simple and radical hysterectomy specimens. The cytological and colposcopical diagnoses prior to conization were reviewed. The cone specimen parameters examined by the pathologists were depth and width of invasion, lymph-vascular space invasion (LVSI) and surgical margins status. The modality used for all conizations, either primary or secondary, was the laser CO(2) under local anaesthesia. RESULTS Diagnosis of MIC was made on cone biopsy in 73 women (81%), in simple hysterectomy in 10 (11%) and in radical hysterectomy specimens in 7 (8%). From the patients that underwent conization, two (2.5%) were detected with LVSI. Five patients (7%) were found to have involved margins and from those, the majority was managed by a second conization. Mean follow-up time was 54 months (range: 30-110 months). Four patients (6.6%) with recurrence were observed during follow-up, all of them with LSIL. No cases of invasive disease or HSIL were encountered. CONCLUSIONS Laser CO(2) conization is a safe and effective mode of treatment for women suffering from MIC and wish to retain their fertility. However, this type of management should be advocated only in cases fulfilling the strict criteria for MIC as these have been defined by FIGO.
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Affiliation(s)
- Emmanuel Diakomanolis
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
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Itsukaichi M, Kurata H, Matsushita M, Watanabe M, Sekine M, Aoki Y, Tanaka K. Stage Ia1 cervical squamous cell carcinoma: conservative management after laser conization with positive margins. Gynecol Oncol 2003; 90:387-9. [PMID: 12893205 DOI: 10.1016/s0090-8258(03)00333-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cone margin status has been reported to be the most important predictor of recurrent disease in patients with cervical intraepithelial neoplasia (CIN) undergoing cervical conization. Our purpose was to evaluate the conservative management of selected patients with microinvasive (FIGO stage Ia1) squamous cell carcinoma who have been treated by cervical conization with positive margins. METHODS Twenty-seven patients underwent KTP laser conization and vaporization for stage Ia1 squamous cell carcinoma followed by careful observation. Involved margins were diagnosed if CIN III or more was present at the ectocervical or endocervical margin and 7 patients formed the basis of the present study. Follow-up consisted of cytology, histology, and pelvic examination. Disease recurrence was defined as a histology diagnosis of CIN III or more on colposcopically directed biopsy or endocervical curettage. RESULTS The endocervical margins were involved by carcinoma in situ in seven (26%) patients. No ectocervical margin involvement was detected. No lymph-vascular space involvement (LVSI) and confluent invasion were seen. All seven patients were free of recurrent disease during median follow-up of 4.0 (range 2.3-7.6) years. CONCLUSION These results suggest that laser conization and vaporization may be a reasonable treatment option in patients with microinvasive (FIGO Stage Ia1) squamous cell carcinoma despite positive cone margins without invasive disease when LVSI is not demonstrated.
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Affiliation(s)
- Mina Itsukaichi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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Abstract
Cervical cancer is a serious health problem, with nearly 500000 women developing the disease each year worldwide. Most cases occur in less developed countries where no effective screening systems are available. Risk factors include exposure to human papillomavirus, smoking, and immune-system dysfunction. Most women with early-stage tumours can be cured, although long-term morbidity from treatment is common. Results of randomised clinical trials have shown that for women with locally advanced cancers, chemoradiotherapy should be regarded as the standard of care; however, the applicability of this treatment to women in less developed countries remains largely untested. Many women with localised (stage IB) tumours even now receive various combinations of surgery and radiotherapy, despite unresolved concern about the morbidity of this approach compared with definitive radiotherapy or radical surgery. Treatment of recurrent cervical cancer remains largely ineffective. Quality of life should be taken into account in treatment of women with primary and recurrent cervical cancer.
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Lee CL, Huang KG, Wang CJ, Yen CF, Lai CH. Laparoscopic radical trachelectomy for stage Ib1 cervical cancer. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:111-5. [PMID: 12555004 DOI: 10.1016/s1074-3804(05)60244-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Radical trachelectomy by vaginal approach is an alternative for young women with early-stage cervical cancer. We modified this procedure to treat two patients with stage Ib1 cervical cancer. With 100% laparoscopic pelvic lymphadenectomy and 80% laparoscopic approach, the technique is laparoscopic radical trachelectomy (LRT). Under direct enhanced vision of the laparoscope, it is easy to identify and preserve ascending branches of the uterine arteries and to divide ligaments surrounding the cervix and vagina. Vaginal procedures require only colpotomy, amputation of cervix, dividing caudal paracolpium, and corpus-vagina anastomosis. Short-term follow-up results of our first patients are satisfactory. Thus, LRT could be a useful alternative for women with early cervical cancer who want to preserve fertility.
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Affiliation(s)
- Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, 5, Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan
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Abstract
PURPOSE OF REVIEW Breast carcinoma, cervical dysplasia and cervical carcinoma are some of the most common forms of precancerous and malignant changes seen in pregnancy due to their prevalence in reproductive age women. The impact of pregnancy on these diseases is complex and needs to be carefully considered for appropriate clinical management. RECENT FINDINGS Recent studies indicate a relationship between hormone levels during pregnancy and subsequent breast cancer risk. For women who have already been diagnosed with breast cancer, retrospective studies show no adverse outcomes on maternal mortality with subsequent pregnancy. Prospective studies are needed to further elucidate these relationships. Recent research evaluating human papilloma virus in pregnant women indicates a similar prevalence of disease among pregnant and nonpregnant patients. Increased rates of human papilloma virus clearance postpartum may be related to an increased immune response within the cervix secondary to the trauma of labor. For women with early stage cervical cancer desiring to preserve future fertility, new trends in treatment allow for preservation of reproductive function. Few recent studies have been conducted regarding the use of chemotherapy during pregnancy, but one study reports increased rates of prematurity after the use of chemotherapy. SUMMARY Continued research is needed regarding the management of breast and cervical cancer during pregnancy in order to optimize treatments and to further our understanding of these disease processes.
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Affiliation(s)
- Renée M Ward
- Department of Gynecology and Obstetrics, The John Hopkins Medical Institutions, Baltimore, Maryland 21287-1248, USA
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Paraskevaidis E, Koliopoulos G, Lolis E, Papanikou E, Malamou-Mitsi V, Agnantis NJ. Delivery outcomes following loop electrosurgical excision procedure for microinvasive (FIGO stage IA1) cervical cancer. Gynecol Oncol 2002; 86:10-3. [PMID: 12079292 DOI: 10.1006/gyno.2002.6650] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goal of this study was to report the delivery outcomes in women who had loop electrosurgical excision procedure (LEEP) for microinvasive cervical cancer (stage IA1 without lymphovascular invasion) and became pregnant and progressed beyond 24 weeks. METHODS A case-control study was performed. Twenty-eight women who were managed exclusively with LEEP for microinvasive cervical carcinoma had at least one pregnancy beyond 24 weeks and were the cases. Each case was matched with one woman who delivered at the same department without prior treatment of her cervix (controls) and their delivery outcomes were compared with those of the cases. Known risk factors for preterm delivery were used as matching factors. RESULTS There was no statistically significant difference (P > 0.05) between cases and controls in the duration of pregnancy (37.6-38.4 weeks respectively), birth weight (3212-3315 g), cesarean section rate (17.8-32.1%), neonatal unit admission rate (21.4-10.7%), and precipitate labor rate (13-10.5%). The duration of labor was significantly shorter in cases (5.5-7.1 h, P = 0.032). After LEEP the relative risk for preterm delivery is 3.67 (95% confidence interval, 0.97-20.27), for low birth weight infant 0.67 (0.06-5.8), for precipitate labor 1 (0.05-3.88), and for delivery by cesarean section 0.5 (0.17-4.46). CONCLUSIONS Women treated for microinvasive cancer with LEEP did not have significantly more delivery complications compared with controls apart from shorter duration of labor. There was a possible non-statistically significant trend toward shorter duration of pregnancy in cases. While caution should be advised when selecting and treating women with microinvasive carcinoma by LEEP, the apparent safety of the management and the satisfactory delivery outcome seem to justify this approach in many cases.
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Jain S, Tseng CJ, Horng SG, Soong YK, Pao CC. Negative predictive value of human papillomavirus test following conization of the cervix uteri. Gynecol Oncol 2001; 82:177-80. [PMID: 11426982 DOI: 10.1006/gyno.2001.6241] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goal of this study was to determine/evaluate the negative predictive value of human papillomavirus (HPV) testing following conization of cervix uteri. METHODS A prospective analysis was undertaken on 79 cone biopsies of women with high-grade lesions (cervical intraepithelial neoplasia (CIN) III). HPV testing was performed on cervical smears before and after conization. We correlated the margin status (defined as positive cone margin or endocervical curettage status) and positive conization HPV status with the residual disease in a hysterectomy specimen. A Digene II kit was used to perform HPV testing. HPV detection was done by Hybrid Capture assay. RESULTS Of the 79 patients, 47(59.5%) had positive margins after conization. HPV testing was positive in 37 cases (78.7%) and negative in 10 cases (21.3%). Residual disease was found in 31 of 47 (66%) postconization hysterectomy specimens. No residual lesions were found in HPV-negative cases. Of the 32 cases with negative margins following conization, HPV testing was negative in 25 cases (78%) and was positive in 7 cases (22%). Among these 25 cases with negative HPV tests, no residual lesion was detected, and in 7 HPV-positive cases, only one residual lesion was found. CONCLUSION HPV testing is potentially an effective tool in predicting residual dysplasia after conization and could potentially assist in the decision between hysterectomy and conservative follow-up in women with CIN III.
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Affiliation(s)
- S Jain
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Elliott P, Coppleson M, Russell P, Liouros P, Carter J, MacLeod C, Jones M. Early invasive (FIGO stage IA) carcinoma of the cervix: a clinico-pathologic study of 476 cases. Int J Gynecol Cancer 2000; 10:42-52. [PMID: 11240650 DOI: 10.1046/j.1525-1438.2000.00011.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The clinical and histologic features of 476 tumors fitting the 1995 FIGO definition of stage IA cervical cancer, treated at a Sydney tertiary referral hospital between 1953 and 1992, are reviewed. Five-year follow-up was complete with a median of 10 years. The diagnosis was increasingly made by histologic examination of colposcopically directed cone biopsy. The majority (88%) of tumors were squamous. The proportion of both younger women (</=35 years) and adenocarcinoma and adenosquamous tumors increased during the second half of the study. Nearly half invaded 1 mm; a third 1.1-3 mm and 20% 3.1-5 mm. Lymph vascular space invasion (LVSI) increased with increasing depth of invasion and was present in over half the tumors invading >3 mm. Treatment was surgical in 99% and was increasingly more conservative as the study progressed with no apparent increase in treatment failure. From 1973 treatment by cone biopsy rose from 6.5 to 35%, by radical hysterectomy fell from 51 to 21% and by lymphadenectomy from 53 to 26%. Only one of 115 patients treated by cone biopsy died. Positive lymph nodes were detected in 1.7% of 180 patients undergoing lymphadenectomy. There were 16 recurrences (3.4%); six vaginal with no cancer deaths, nine pelvic and one distant, with nine deaths and three new cancers (two deaths). Univariate analysis suggests that older age, glandular tumors and those invading 3 mm were associated with more treatment failures and multivariate analysis showed that both conservative hysterectomy and the omission of lymphadenectomy are associated with higher recurrence rates with >3 mm invasion. The study failed to resolve the dilemma of predicting those tumors with a poor prognosis.
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Affiliation(s)
- P. Elliott
- Departments of Gynaecological Oncology, Anatomical Pathology and Radiation Oncology, King George V. (Royal Prince Alfred Hospital), Sydney and The Clinical Trials Center, University of Sydney, Sydney Australia
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Tseng CJ, Liang CC, Lin CT, Huang KG, Chou HH, Chang TC, Lai CH, Soong YK, Hsueh S. A study of diagnostic failure of loop conization in microinvasive carcinoma of the cervix. Gynecol Oncol 1999; 73:91-5. [PMID: 10094886 DOI: 10.1006/gyno.1998.5295] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the specimen adequacy and the histological interpretation of loop conization for microinvasive cervical carcinoma. METHODS We retrospectively reviewed the histopathological findings of the original cone specimens together with the final hysterectomy specimens in patients with microinvasive carcinoma of the cervix. From 1990 to 1995, 63 consecutive patients with microinvasive carcinoma of the cervix were included in the study, of which 35 patients underwent loop conization and 28 underwent cold-knife conization. All patients had a hysterectomy. RESULTS The mean width, depth, and cone volume of the conization specimens were 2.44 cm, 2.15 cm, and 3.96 cm3, respectively, in the loop group versus 2.3 cm, 2.35 cm, and 4.38 cm3 in the cold-knife group. No significant differences were seen between the two groups. The application of loop conization was completed in a single slice in 27 patients (77.1%) and multiple slices by the loop in 8 (22.9%), in spite of the attempt to perform conization in a one-pass application when possible. In assessing these cone specimens microscopically, the rate of transection of tissue was significantly higher in the loop cone than in the cold-knife cone (17.1% versus 0%, P = 0.02). Because of transection of tissue and misorientation, pathologic determination of the depth and width of stromal invasion was undetermined in two loop cone specimens compared with none in the cold-knife cones. CONCLUSION Our study suggests that cold-knife conization is a preferred method in assessing microinvasive carcinoma of the cervix if multiple applications of loop conization are inevitable.
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Affiliation(s)
- C J Tseng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Abstract
OBJECTIVE To evaluate the prognosis of patients with stage IA1 and IA2 microcarcinoma of the cervix according to the 1994 FIGO classification. METHODS The histologic specimens of 494 patients who underwent conization for microcarcinoma of the cervix between 1958 and 1992 were reviewed and classified according to the 1994 FIGO system. RESULTS After a mean follow-up of 14 years (range, 1-35) 2 patients with stage IA1 tumors and 2 patients with stage IA2 tumors died of disease. Patients with early stromal invasion only accounted for 70% of patients with stage IA1 lesions. If these patients are excluded from stage IAI, the mortality rates for stage IA1 and IA2 did not differ significantly. Surgical radicality declined markedly during the study period. CONCLUSION Neither the 1985 nor the 1994 FIGO classification of microcarcinoma can be used as a guide to therapy. Conization only suffices for patients with early stromal invasion or a depth of invasion of 1-3 mm without lymph vascular space involvement. Additional pelvic lymphadenectomy can be considered for patients with stage IA1 lesions with lymph vascular space involvement. Removal of the tumor and pelvic lymphadenectomy is indicated for all patients with stage IA2 lesions, regardless of lymph vascular space involvement. Radical vaginal or radical abdominal hysterectomy represent overtreatment for patients with microcarcinomas because parametrial involvement in these patients has not been demonstrated.
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Affiliation(s)
- R Winter
- Department of Obstetrics and Gynecology, University of Graz, Austria
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