Abstract
PurposeTo compare the techniques for cone measurement with ultrasound to determine the size of the resected tissue and to evaluate parameters which may be relevant for stratifying women at risk who need surveillance when pregnant.MethodsThe present study included women with a pathological cervical biopsy. Cervical length and volume were determined by transvaginal ultrasound prior to conization. The pathologist measured the volume of the removed tissue by the fluid displacement technique and using a ruler. A repeat transvaginal ultrasound was performed during a follow-up visit. Factors affecting cone volume as well as the correlation between measurement techniques were analyzed.ResultsA total of 28 patients underwent cervical excision treatment. The mean cervical volumes measured sonographically before and after the operation were 17.72 ± 7.34 and 13.21 ± 5.43 cm3, respectively. The proportion of volume excised was 25.50 ± 17.43%. A significant correlation was found between the cone depth and the cone volume measured by the fluid displacement technique, and histopathologically and sonographically measured difference in cervical volume. The interobserver reliability coefficient was > 0.9. Analyzing influential parameters, only age affected the extent of cone volume and the correlation between the three measurement techniques.ConclusionCommonly applied techniques of cervical and cone measurement are equivalent and interchangeable. Our ultrasound data show variety in the volume and length of the cervix, and in the proportion of the volume excised at conization. Ultrasound measurements may help the surgeon to estimate not only the dimension of the remaining cervix but also its function.
Highlights
The implementation of cervical carcinoma screening in various countries and the introduction of HPV vaccination have contributed to a significant decrease in the incidence and mortality rates for this cancer [1]
The background characteristics of each patient recorded at inclusion were: age, parity, tobacco use, oral contraceptive use, HPV status, history of cervical intraepithelial neoplasia (CIN) treated by conization, preferences for subsequent pregnancy, and post-operative complications requiring additional surgery
Our ultrasound data show great variety in the volume and length of the cervix and in the proportion of the volume excised at conization, which seems to more accurately reflect the extent of damage to the cervix [11] and to be more relevant for the post-operative function of the cervix than the cone volume itself
Summary
The implementation of cervical carcinoma screening in various countries and the introduction of HPV vaccination have contributed to a significant decrease in the incidence and mortality rates for this cancer [1]. A decrease in invasive cervical cancer is ensured by the timely diagnosis and appropriate treatment of high-grade preinvasive cervical lesions using cytology. Excisional treatment methods may lead to a higher risk of adverse obstetric outcomes in affected fertile women [5,6,7,8]. Women who have undergone cervical excision treatment have relatively short mid-trimester cervical lengths [9] and are at an increased risk of preterm delivery [10]. The cervical length, volume, or proportion of excised tissue may be relevant for stratifying women at
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