Cervical Cold Knife Conization Research Articles

Analysis of adverse late-term pregnancy outcomes after cervical cold knife conization

Objective: To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization. Methods: The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed. Results: (1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm3 and cone size <2 cm3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference (P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm (RR=3.084, 95%CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm3 and those with cone size ≥2 cm3 (RR=1.700, 95%CI: 0.935-3.092; P=0.077). Conclusion: The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.

The Effect of Cervical Cold-Knife Conization (CKC) on HPV Infection in Patients with High-Grade Cervical Intraepithelial Neoplasia: A Retrospective Study.

Investigation of HPV infection treatment in women undergoing cervical cold-knife conization for advanced cervical intraepithelial neoplasia. A retrospective analysis was conducted on patients who underwent cervical cold-knife conization for cervical intraepithelial neoplasia grade II-III at Beijing Obstetrics and Gynecology Hospital from January 2017 to December 2018. The HPV infection status of the patients at 6 months, 1 year, and 2 years after surgery was collected. We use chi square analysis and binary logistic regression to evaluate various factors such as age, number of pregnancies, number of cesarean sections, number of vaginal deliveries, HPV type, size of surgical specimens (diameter and height), and the influence of specimen edge on HPV infection. A total of 334 patients were included in the analysis. The patients are mainly infected with HPV 16/58/52. Age is a influencing factor for HPV recovery 12 months after CKC surgery (P=0.002). Based on the diagnosis of HPV one year after CKC, the recovery rate of HPV58 patients is significantly lower than HPV16. Age is a influencing factor for the recovery of HPV infection (P<0.05). The treatment of HPV infection by CKC is related to the patient's age and HPV subtype but not to number of pregnancies, number of pregnancies, number of vaginal deliveries, size of surgical specimens, and marginal conditions. The rate of HPV negative conversion is relatively high 24 months after the patient does not undergo surgery, but there is currently a lack of data on cervical lesions that match HPV results.

The characteristics of the residual disease after cervical conization: A retrospective analysis from a tertiary gynecological cancer center.

Patients with a biopsy-confirmed cervical intraepithelial neoplasia 2 and 3 have an increased risk of disease progression to invasive cancer and should be treated with an excisional method. However, after treatment with an excisional method, a high-grade residual lesion may remain in patients with positive surgical margins. We aimed to investigate the risk factors for a residual lesion in patients with a positive surgical margin after cervical cold knife conization. Records of 1008 patients who underwent conization at a tertiary gynecological cancer center were retrospectively reviewed. One hundred and thirteen patients with a positive surgical margin after cold knife conization were included in the study. We have retrospectively analyzed the characteristics of the patients treated with re-conization or hysterectomy. Residual disease was identified in 57 (50.4%) patients. The mean age of the patients with residual disease was 42.47 ± 8.75 years. Age greater than 35 years (P = 0.002; OR, 4.926; 95%CI [Confidence Interval] - 1.681-14.441), more than one involved quadrant (P = 0.003; OR, 3.200; 95% CI - 1.466-6.987), and glandular involvement (P = 0.002; OR, 3.348; 95% CI - 1.544-7.263) were risk factors for residual disease. The rate of high-grade lesion positivity in post-conization endocervical biopsy at initial conization was similar between patients with and without residual disease (P = 0.16). The final pathology of the residual disease was microinvasive cancer in four patients (3.5%) and invasive cancer in one patient (0.9%). In conclusion, residual disease is found in about half of the patients with a positive surgical margin. In particular, we found that age greater than 35 years, glandular involvement, and more than 1 involved quadrant were associated with the residual disease.

The treatment strategy of patients with positive margins after cervical cold knife conization-A 7-year retrospective study in China.

To explore treatment strategies for patients with positive margins after cervical cold knife conization (CKC) by estimating the risk of residual or recurrent CIN2 or worse (CIN2+). A retrospective study included 569 patients receiving CKC for CIN3 in Xiangya Hospital from January 2013 to December 2017. Demographic characteristics and test results were obtained before CKC, after CKC, at 6, 12, and 24months, then annually thereafter. The primary end point was residual/recurrent CIN2+ post-CKC. Fourteen (2.46%) patients had residual/recurrent CIN2+ with a median time of occurrence at 12months post-CKC. Taking the average age and hrHPV viral load tested by Hybrid Capture 2 (HC2) as thresholds, the risk of residual/recurrent CIN2+ was higher in women aged over 40years or with a baseline HC2 of 300 or more for the ratio of relative light units to positive cut-off values. Patients with positive margins were at higher risk of residual/recurrent CIN2+ (hazard ratio 3.66, 95% confidence interval 1.25-10.71), especially when endocervix was involved. A total of 536 (94.20%) patients received HPV testing within 6months after CKC. Patients with both positive HPV testing results and positive margins were at the highest risk of residual/recurrent CIN2+. Patients with positive endocervical margins are at high risk for residual/recurrent CIN2+, independent of the severity of margins. HPV testing within 6months after CKC may be a feasible triage strategy for these patients.

Analysis of the effect of cervical conization through cervical endoscopy in the treatment of High-grade cervical intraepithelial neoplasia

Objective To investigate the clinical effect of cervical conization under cervical endoscopy in high-grade cervical intraepithelial neoplasia (CIN). Methods From June 2017 to June 2019, 100 patients with grade II and III CIN admitted to Harbin First Hospital were divided into control group and observation group with 50 cases in each group by random number table method.The control group was treated with traditional cervical cold knife conization, while the observation group was treated with cervical conization under endoscopy.To compare the therapeutic effects of two surgical methods. Results The incidence of positive margin were significantly lower than that in the control group(8%(4/50) and 18%(9/50)), and the difference was statistically significant (χ2=4.98, P 0.05). Conclusion The cervical conization through cervical canal endoscope can accurately locate the focus of high-grade CIN, with higher rate of lesion clearance, lower rate of lesion recurrence and complications. Key words: Conization of cervix; Endoscopy; Cervical intraepithelial neoplasia

Observation on the curative effect and pregnancy outcome of early cervical cancer patients undergoing fertility function retention surgery via laparoscopy

Objective To analyze the outcome of oncology and pregnancy on patients with early-stage cervical cancer after undergoing fertility function retention surgery via laparoscopy. Methods Sixty-seven patients with early cervical cancer treated in Huangshi Central Hospital from January 2011 to January 2015 were selected as the research subject; 27 patients in the research group were given fertility-sparing operation, also known as transvaginal cervical cold knife conization(CKC) and laparoscopic pelvic lymphadenectomy (PLD) or total laparoscopic uterine cervix extensive resection(RT)), and the patients in the control group(40 cases)were given laparoscopic uterine extensive resection(RH); the perioperative condition, intraoperative condition and postoperative recurrence of two groups were compared, and the postoperative pregnancy status of the patients in the research group were analyzed. Results Among the 27 patients in the research group, 2 patients whose intraoperative pathological examination results did not meet the standards for the fertility-sparing operation were finally treated with RH, and the other 25 patients were successfully given CKC+ PLD or RT; In the research group, the intraoperative blood loss, postoperative exhaust time and hospital stay were better than those in the control group, and the differences were statistically significant (intraoperative blood loss: (85.6 + 25.5) ml, (102.5±31.2) ml, t=2.429, P=0.018; postoperative exhaust time: (1.4±0.3) d, (1.7±0.5) d, t=3.065, P=0.003; hospital stay : (10.2±2.4) d and (12.3±3.5), t=2.913, P=0.005), there was no statistically significant difference between the two groups in the operation time, incidence of urinary retention and postoperative infection (P>0.05); the differences between the two groups in the number of removed pelvic lymph nodes, length of cardinal ligament, length of uterosacral ligament, length of removed vaginal were not statistically significant(P>0.05); after 24 months of follow-up, the difference in postoperative recurrence rate of the two groups(4.0% (1/25)vs.5.0%(2/40)) was not statistically different (P>0.05); among 25 patients with fertility-sparing operation, 20 patients had pregnancy desire, and 6 patients were successfully pregnant(6/20), including 2 cases of full-term labor, 2 cases of preterm delivery and 2 cases of abortion. Conclusion Fertility-sparing surgery via laparoscope of early cervical cancer has good curative effect and reliable security, but the outcome of pregnancy is not ideal, and need to be improved. Key words: Cervical cancer; Fertility function retention; Laparoscope; Curative effect; Pregnancy outcome

Analysis of pregnancy outcome in patients with cervical cancer after cervical cold knife conization

Objective To explore the effect of pregnancy outcome with cervical cold knife conization in pa -tients with early stage cervical cancer .Methods 23 patients with cold knife conization and 21 patients with radical trachelectomy were collected .The pregnancy outcome and perinatal infants between the two groups were compared . Results The pregnancy rate was 82.6%in the observation group,71.4%in the control group,there was statistically significant difference（χ2 =8.654,P=0.002）;the section rate was 37.5% in the observation group,30.8% in the control group,there was statistically significant difference （χ2 =9.645, P =0.000 ）;10 cases of term delivery （62.5%）and birth weight was（3.27 ±1.15）in the observation group,term delivery（69.2%）and birth weight was （2.81 ±0.96）in the control group,proportion and birth weight were statistically significant differences （χ2 =11.671, P=0.000）（t =9.683,P=0.000）;there were statistical significance in the outcome of pregnancy （Fisher P=0.036）and perinatal infants（Fisher P=0.034）among patients with different cervical conization height;the relapse rate was 4.4% in observation group,9.5% in the control group,the relapse rate of the two groups had significant difference（Fisher P =0.039）.Conclusion Compared with radical trachelectomy ,patients treated by cold knife conization has high pregnancy rate and high cesarean section rate ,which can influence the outcome of pregnancy and perinatal infants . Key words: Uterine Cervical Neoplasms; Postoperative Period; Gravidity

Clinical management of cervical intraepithelial neoplasia in pregnant and postpartum women

To evaluate the clinical management of cervical intraepithelial neoplasia (CIN) and cervical microinvasive squamous cell carcinoma in pregnant and postpartum women. This prospective study enrolled 27,230 pregnant women undergoing routine gestational examinations between August 1, 2007 and July 31, 2010 in the Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Colposcopy and cervical biopsy were performed for patients with abnormal Thin Prep® Papanicolaou test (TCT) results. Periodic colposcopy was performed every 8-12 weeks and cervical biopsy was performed if progression was suspected. Cervical cold knife conization was recommended to patients diagnosed with CINIII or microinvasive cervical carcinoma 6-12 weeks after delivery. A total of 2,260 patients had abnormal TCT results (8.12 %). Colposcopy and cervical biopsy were performed for 369 patients. Fifteen patients had microinvasive squamous cell carcinoma, 116 patients had cervicitis, and the number of CIN patients with histological grades I, II, and III were 124, 49, and 65, respectively. Tumor progression during pregnancy was found in 253 patients (CINI or above). Prognosis varied depending on the highest grade of pathological diagnosis results during pregnancy or initial pathological diagnosis results performed 6-12 weeks after delivery by cervical biopsy under colposcopy. Treatment and follow-up were carried out according to diagnoses, state of progression, and reversion (if any). These findings underline a need for cervical lesion screening for all women during pregnancy, and colposcopy should be performed for pregnant women who have abnormal TCT results. Appropriate treatment and follow-up were recommended according to different diagnosis of CIN.

Loop conization for the treatment of microinvasive carcinoma of the cervix

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.

The influence of time intervals between loop electrosurgical excision and subsequent hysterectomy on the morbidity of patients with cervical neoplasia

Objective To improve clinical prospects by reducing intraoperative or postoperative complications, subsequent hysterectomy is generally conducted within 48 h or 6 weeks after cervical cold-knife conization. The loop electrosurgical excision procedure (LEEP) is widely used for cervical conization. However, no study has ever been undertaken on the relation between postoperative sequelae and the time between LEEP and hysterectomy. Therefore, this study was undertaken to evaluate the correlations between postoperative sequelae and the interval between LEEP and hysterectomy. Methods The medical records of 338 patients, who underwent type 1 extended hysterectomy after LEEP at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine, were retrospectively reviewed. The subjects were divided into three groups according to time from LEEP to hysterectomy: group 1 (within 48 h, n = 210), group 2 (between 48 h and 6 weeks, n = 88), and group 3 (>6 weeks, n = 40). Results The three groups showed no significant differences with respect to patient characteristics (age, delivery history, body mass index, and a history of surgery). Postoperative complications such as fever, dysuria, and surgical region complications (effraction, infection, and rubefaction) were not significantly different among the three groups. Other complications, namely, ureter injury and abdominal wall hematoma, were found in one case in each group 1. Conclusion The postoperative clinical courses were not significantly different regardless of time interval between LEEP and subsequent hysterectomy. Therefore, hysterectomies can be conducted at any time when the patient is in an appropriate condition, i.e., not precisely within 48 h or >6 weeks after LEEP.

Recurrent Invasive Adenocarcinoma after Hysterectomy for Cervical Adenocarcinoma in Situ

Background. Unlike its squamous counterpart, therapy for cervical adenocarcinoma in situ with positive endocervical cone margin remains controversial.Case. A 52-year-old gravida 2, para 1,0,1,1, presented with vaginal bleeding. Gynecologic history was significant for cervical cold knife conization with a positive endocervical margin and endocervical curettage with atypical endocervical cells. Repeat cone biopsy was considered unsafe given the large initial cone specimen. An extrafascial hysterectomy was performed 5 weeks later and pathology confirmed a disease-free cervix. Pap smear performed 1 year later was interpreted as recurrent adenocarcinoma but later downgraded to inflammation. Inspection and random biopsies of the vaginal cuff revealed only inflammation. Two subsequent Pap smears also returned inflammation. Seventeen months after the hysterectomy physical examination revealed a 2 × 3-cm smooth mass at the vaginal cuff. Biopsy revealed invasive adenocarcinoma. The patient underwent an upper vaginectomy followed by postoperative pelvic radiation.Conclusion. This case suggests that despite extrafascial hysterectomy for presumed adenocarcinoma in situ of the cervix, a residual focus could remain and present later as invasive adenocarcinoma.

Outcomes after Cervical Cold Knife Conization with Complete and Incomplete Excision of Abnormal Epithelium: A Review of 699 Cases

A retrospective analysis was undertaken of 699 cone biopsies performed at the Royal Women's Hospital in Melbourne from 1966 to 1992. In 572 cases (82%), abnormal epithelium was assessed as having been completely excised, and in 127 (18%) excision was incomplete. There were no significant differences in age, parity, cytology, histology, or indications for conization between patients in whom excision was incomplete and those in whom complete excision was achieved. Of the patients whose cone biopsy histology showed complete excision of abnormal epithelium, 96.7% were found to have been cured of disease on the basis of normal follow-up or normal histology of hysterectomy specimens. The overall cure rate after incomplete cone biopsy was found to be 77%, but was influenced by the site of incomplete excision. The cure rate for incomplete excision at the ectocervical margin was 86%; incomplete excision at the endocervix was 68% and only 40% if excision was incomplete at both edges. Cone biopsy undertaken for cervical intraepithelial neoplasia is likely to be curative when the lesion is completely excised, but recurrent disease may occur and adequate follow-up is an essential part of patient management after conization, regardless of histological findings in the conization specimen. Most cases of incompletely excised cervical intraepithelial neoplasia will also be cured, especially if the incomplete margin is ectocervical, and cytological and colposcopic follow-up may be an acceptable alternative to repeat cone biopsy or hysterectomy in the management of such cases.