Cervical Loop Excision Research Articles

A Heterogeneous Renal Mass and Arm Pain in a 38-Year-old African American Female

A 38-year-old African American woman presented with a 3-month history of worsening right arm pain. Initial conservative management included analgesia and myofascial release by the patient's primary care physician. She continued to have focal pain of the right humerus, and plain-film imaging demonstrated a lytic lesion of the diaphyseal humerus. Subsequent computed tomography (CT) confirmed a large renal heterogeneous mass replacing the renal parenchyma (Fig. 1). The patient's medical history included sickle cell trait and iron deficiency anemia, and her surgical history included a cervical loop excision for an abnormal Pap smear.

A Randomized Trial of Buffered Versus Nonbuffered Lidocaine With Epinephrine for Cervical Loop Excision

Our study evaluated whether buffering reduces pain from lidocaine injection for loop electrosurgical excisional procedures (LEEPs) of the cervix when compared to unbuffered lidocaine. Women undergoing outpatient LEEPs were randomized to receive either buffered or unbuffered lidocaine. Participants, caregivers, and statisticians were blinded to treatment allocation. Pain was categorized as injection, procedure, or cramping pain. Severity of pain was reported using a Likert visual analog scale and compared using Mann-Whitney tests. Twenty-eight subjects received buffered lidocaine and 24 subjects received unbuffered lidocaine. The 2 groups were similar in regard to age, race, previous LEEP, anesthetic volume used, and loop size. Mean scores were similar between the nonbuffered and buffered groups for injection pain (25 vs 19, p = .13), procedure pain (27 vs 19, p = .08), and cramping pain (19 vs 18, p = .86). Pain scores with subepithelial lidocaine plus epinephrine for LEEP are low and are not significantly reduced by buffering the anesthetic.

Endocervical crypt involvement by high‐grade cervical intraepithelial neoplasia after large loop excision of transformation zone: Do we need a different follow‐up strategy?

The aim of this study was to determine the effect of endocervical crypt involvement in specimens with clear margins on recurrence following large loop excision of transformation zone (LLETZ). This was an observational cohort study. In the colposcopy unit in a university teaching hospital we prospectively collected data for women who underwent LLETZ treatment for high-grade cervical intraepithelial neoplasia (CIN) between 2003 and 2004. We determined the difference in recurrence rate and need for repeat treatment between groups with and without crypt involvement in the primary histology. We prospectively collected data of follow up until 2010. The recurrence was analyzed using Cox regression. A total of 309 women had complete excision of the margins following LLETZ treatment for CIN 2 or 3. There was no significant difference in age between groups with (30.2) and without (29.7) crypt involvement (P<0.25). There was a significant difference in the prevalence of abnormal smear results before and after LLETZ between groups with or without crypt involvement (P=0.043). The need to perform a repeated treatment was significantly different between groups with and without crypt involvement (P<0.024). A full model significantly predicted recurrence of cervical pathology (P<0.009) that necessitated treatment when crypt involvement was present. The odds ratio for repeat treatment with crypt involvement was 2.67 (confidence interval, 1.27-5.64). Our study showed that positive involvement of endocervical crypt by CIN in a cervical loop excision specimen increases the frequency of subsequent episodes of treatment.

Pilot feasibility study of the reporting of cervical loop excision biopsies by advanced biomedical scientist practitioners

Pilot feasibility study of the reporting of cervical loop excision biopsies by advanced biomedical scientist practitioners

Successful Pregnancy Following Treatment of Cervical Stenosis from a Previous Cervical Loop Excision

Background: Cervical stenosis as a result of a loop excision procedure is a rare but late complication of this procedure. For women desiring pregnancy, in vitro fertilization (IVF) embryo transfer is very challenging. Case: A 35-year-old woman para 1001 presented with secondary amenorrhea from cervical stenosis 2 years after a normal spontaneous vaginal delivery, as a result of a loop excision procedure of the cervix performed 6 weeks postpartum. Results: Her cervical stenosis was resolved by a novel cervical procedure resulting in a successful transcervical IVF embryo transfer. Conclusions: Cervical factors accounts for 5% of all referrals for infertility. A novel procedure to resolve cervical stenosis and a resultant successful transcervical embryo transfer is reported. (J GYNCOL SURG 28:23)

Pseudoinvasion of benign squamous epithelium following cervical biopsy: a pseudoneoplastic phenomenon mimicking invasive squamous carcinoma

AimsTo describe an unusual and hitherto unreported pseudoneoplastic phenomenon that is characterised by the entrapment of benign squamous epithelium following cervical loop excision or punch biopsy and that may mimic...

Efficiency of immunohistochemical p16 expression and HPV typing in cervical squamous intraepithelial lesion grading and review of the p16 literature

Diagnosing and grading cervical cancer precursors is challenging. This study investigates the presence of HPV infection, the expression of p16, and any correlation between these two findings. H&E-stained slides of cervical loop excision materials diagnosed as LSIL and HSIL were reviewed. An immunohistochemical panel consisting of p16 as well as of all HPV types and HR-HPV types was applied. Staining of p16 was evaluated according to distribution extent and degree of intensity. All HSIL cases and 80% of LSIL cases were positive for p16. In HSIL cases, the staining distribution was as follows: 50% full thickness, 45% basal, and 5% rare. The staining intensity for the same cases was strong in 70%, variable in 20%, and weak in 10% accordingly. In LSIL cases, staining distribution was basal in 58.3% and rare in 41.7%. None of the LSIL cases showed full thickness of p16 positivity. The staining intensity of the same cases was strong in 25%, variable in 16.7%, and weak in 58.3%. Of all cases, 48.6% were positive for screening kit (all HPV types), and 31.4% of all cases were positive for HR-HPV. The distribution of this positivity was 35% for HSIL and 26.6% for LSIL cases. The total HPV-type positivity rate was 48.6%, the distribution being 50% for HSIL and 46.6% for LSIL cases. p16 is a highly sensitive marker for cervical epithelial dysplasia. Strong and full thickness staining of p16 in the cervix epithelium is highly supportive of HSIL, while weak and basal/rare staining favors LSIL. All HPV-positive cases were also p16-positive, but no statistically significant relationship between HPV infection positivity and the intensity and distribution of p16 was found. HPV is not helpful in the grading of SIL, as an unignorable rate of HR-HPV positivity (26.6%) was detected in LSIL group.

ELECTROSURGICAL LOOP EXCISION OF THE CERVIX

This article discusses the technique of cervical electrosurgical loop excision, which allows for treatment of premalignant conditions of the cervix. The primary goal of cervical loop excision is to provide a method of managing preneoplastic cervical conditions in a safe, effective manner while minimizing the chance of missing invasive cancer. Topics discussed include equipment and supplies, procedural pearls, complications, and so forth.

Is loop excision adequate primary management of adenocarcinoma in situ of the cervix?

To assess the efficacy of cervical loop excision as primary management of adenocarcinoma in situ. A two-centre retrospective study. Birmingham and Midlands Hospital for Women and City Hospital NHS Trust. Nineteen women with a histological diagnosis of adenocarcinoma in situ (high grade CIGN) of the cervix made on diathermy loop excision. Presence or absence of adenocarcinoma in situ at loop specimen margins, results of cervical cytological examinations following loop excision, results of histopathological assessment of any surgical specimens taken after initial loop excision. Of the 19 women with confirmed adenocarcinoma in situ on loop excision, the median age was 31, and 8 (42%) were nulliparous. The median follow up of these women was 19 months. Eleven women were treated by loop excision alone and have had normal follow up to 18 months. Five women have undergone further surgical procedures, four had a hysterectomy and one had a repeat loop excision. No residual disease was found in any of these surgical specimens, confirming that loop excision was adequate primary management of the disease. Three women have had abnormal endocervical follow up cytology suggestive of residual disease. One of these three women may represent a case of residual endocervical disease. Excision margins of the loop specimen were not involved by adenocarcinoma in situ in 11 women. However, excision margin status of the loop specimen did not appear to be predictive of residual disease. Our small retrospective study suggests that diathermy loop excision of the cervix is adequate primary management of adenocarcinoma in situ of the cervix. Cytological and colposcopic follow up, including cytobrush endocervical cytological sampling and long term follow up, is recommended in these women.

Efficacy of and Prognostic Factors in Cervical Loop Excision

Efficacy of and Prognostic Factors in Cervical Loop Excision

Frozen-Section Analysis of Cervical Loop Excision Versus Cone Biopsy Before Planned Hysterectomy

Frozen-Section Analysis of Cervical Loop Excision Versus Cone Biopsy Before Planned Hysterectomy

Correlation Between Colposcopically Directed Biopsy and Cervical Loop Excision

Correlation Between Colposcopically Directed Biopsy and Cervical Loop Excision

Correlation between Colposcopically Directed Biopsy and Cervical Loop Excision

Colpscopy is standard for diagnosis of cervical cancer precursors, but the development of diathermy loop electrodes for excision of the cervical transformation zone offers a technique for validation. Loop excision of the transformation zone was performed for 47 consecutive women with dysplasia in colposcopically directed biopsies using 20 × 8-mm electrodes. Specimens were marked for orientation and serially sectioned. All pathology material was reviewed. Although 28% of women had disappearance of dysplasia at the biopsy site, only 9% had no dysplasia in the transformation zone. Half of the women with CIN 1 on directed biopsy had high-grade lesions found in loop excision specimens. Significant discrepancies may be found between the results of colposcopically directed biopsy and loop excision.

Climate in Asthma

Climate in Asthma