Knife Conization Research Articles

Evaluation of Cold Conization Indications and Results

Objective: The aim of this study was to determine the efficiency and indications of cold knife conization in the treatment of high-grade cervical lesions. Materials and Methods: This study included patients with high-grade cervical lesions treated with cold knife conization (CKC) within 9 years. Histopathological correlation analyses were carried out among the smear, colposcopic biopsy (CBx), CKC results, and total hysterectomy specimens available. Results: One hundred thirty-one cold knife cone biopsy cases were analyzed for this study. The most common pathology was cervical intraepithelial neoplasia (CIN) II–III, with a frequency of 64 (48.9%). Other conization results in order of frequency were as follows: CIN I at a rate of 29 (22.1%), Carcinoma (Ca) at 19 (14.5%), cervicitis at 14 (10.7%), and negative results at 5 (3.8%). Conclusions: CKC remains an acceptable option in the treatment of CIN and microinvasive carcinoma of the cervix, and the excellent diagnostic and therapeutic efficacy of CKC is well-known and confirmed. When properly performed, the procedure has a low risk of complications and provides an accurate histological representation of the disease process. It is also curative in most cases. Of course, excellent clinical results still require careful, long-term, and attentive follow-up.

Follow-up of women with cervical adenocarcinoma in situ treated by conization: A single centre clinical experience

ObjectiveHysterectomy has been the historical gold standard final step in the treatment algorithm of adenocarcinoma in situ (AIS) recommended by most North American colposcopy guidelines. AIS disproportionately affects young childbearing age women, therefore a fertility sparing treatment option is desirable. Our study examines the impact of conservative treatment of AIS with conization followed by serial surveillance. MethodsA retrospective chart review was completed of patients treated for AIS from 2006 to 2020. Charts were identified by pathologic diagnosis of AIS on cervical and uterine specimens. Charts were excluded if AIS was not treated with conization, if AIS was not confirmed on initial conization specimen, or if invasive disease was found at initial conization. Results121 patient charts were analyzed. Median age of patients at first conization and hysterectomy was 34.8 and 40.9, respectively. First conization was by Cold Knife Cone in 58% of patients, and by Loop Electrosurgical Excisional Procedure in 42% of patients. Median follow-up period in our study was 609 days. 5% of patients had recurrence, with only one patient who recurred as cancer. One case of recurrence had a positive initial conization margin. Median time to recurrence was 700 days. 47% of patients underwent eventual hysterectomy. Residual AIS was found in 23% of hysterectomy specimens. Adenocarcinoma was diagnosed on hysterectomy specimen in four patients. ConclusionOur study demonstrates the oncologic safety of treating AIS with conization and serial surveillance. Routine hysterectomy completed as a part of the AIS treatment algorithm, as in current clinical guidelines, is unnecessary.

Minor rotor tines and knives soil interaction. Total power calculation for minor rotor drive

Introduction. The problem of fast and high-quality road construction, when economic facilities and settlements are spatially separated, located at a considerable distance from each other, cannot be solved without the use of a complex of continuous units. An important element of the continuous unit forming the ditch and the unit for tunneling is the direct-flow rotary ripper. Current theoretical studies are not sufficient to calculate the interaction with the soil of the elements of a direct-flow rotary ripper. The lack of theoretical justification for the parameters of direct-flow rotary rippers hinders their use. Therefore, there is a need for theoretical research to identify the geometric, kinematic, dynamic and energy parameters of structural elements.The method of research. Methods for calculating the required power to drive the teeth, to separate the seam from the soil mass with knives and divide it into fragments, to overcome the inertia force of the incoming soil on two small rotor knives, to accelerate the soil towards the large rotor, to move the soil towards the large rotor, to overcome the friction force of the soil on the front surface of the knives have been developed. The total power required to drive the small rotor corresponds to the sum of the powers: for the introduction of a cone with a spiral knife into the ground, for the drive of the teeth and for the drive of the knives.Results. On the basis of the developed methods, the parameters were calculated. From the flat and spatial model of the forces of interaction with the ground of the elements of the small rotor, their resultant, their components, and normal forces are revealed. The friction force of the soil on the front surface of the knife is calculated. The total power for the drive of the small rotor and the volumetric energy for the introduction of the small rotor into the ground are calculated.Conclusion. The energy costs for driving small rotor knives include: energy for separating the reservoir and dividing it into fragments, energy for overcoming the pressure of the soil on the front surface of the knife, energy for accelerating the soil, energy for moving the soil, energy for overcoming the friction force of the soil on the front surfaces of the knives. The total energy cost of the small rotor drive includes the energy required to introduce the spiral knife cone, teeth and knives of the small rotor into the ground. As a result of the calculations, the power to drive the teeth of the small rotor is 735 W, the total power required to drive the small rotor is 2.2 kW. The volumetric energy for the introduction of a small rotor into the ground is 33.1 kJ / cubic meter.

Conservative Treatment of Stage IA1 Cervical Carcinoma Without Lymphovascular Space Invasion: A 20-year Retrospective Study in Brazil.

To evaluate recurrence rates and risk factors among women with stage IA1 cervical cancer without lymph vascular space invasion managed conservatively. retrospective review of women with stage IA1 squamous cervical cancer who underwent cold knife cone or loop electrosurgical excision procedure, between 1994 and 2015, at a gynecologic oncology center in Southern Brazil. Age at diagnosis, pre-conization findings, conization method, margin status, residual disease, recurrence and survival rates were collected and analyzed. 26 women diagnosed with stage IA1 squamous cervical cancer without lymphovascular space invasion underwent conservative management and had at least 12 months follow-up. The mean follow-up was 44.6 months. The mean age at diagnosis was 40.9 years. Median first intercourse occurred at age 16 years, 11.5% were nulliparous and 30.8% were current or past tobacco smokers. There was one Human immunodeficiency virus positive patient diagnosed with cervical intraepithelial neoplasia grade 2 at 30 months after surgery. However, there were no patients diagnosed with recurrent invasive cervical cancer and there were no deaths due to cervical cancer or other causes in the cohort. Excellent outcomes were noted in women with stage IA1 cervical cancer without lymphovascular space invasion and with negative margins who were managed conservatively, even in a developing country.

HPV vaccination following loop electrical excision procedure (LEEP) for cervical intraepithelial neoplasia: A cost-effectiveness analysis (134)

Objectives: Excisional cervical procedures, such as a Cold Knife Cone (CKC) or a loop electrical excision procedure (LEEP), are standard treatments for moderate to severe cervical intraepithelial neoplasia (CIN). Human papillomavirus (HPV) is the causal agent for CIN and can persist or recur; thus, patients can be susceptible to recurrent CIN following excision. Some data suggest that CIN recurrence rates decrease with HPV vaccination after LEEP. Here, we aimed to examine the cost-effectiveness of HPV vaccination following LEEP procedures compared with no vaccination. Methods: We constructed a decision-analytic model (TreeAge Pro 2021) to compare outcomes between patients who underwent LEEP followed by HPV vaccination with those who underwent LEEP without HPV vaccination. Our theoretical cohort contained 250,000 patients, the approximate number of patients who had LEEPs per year in the United States. Our outcomes were costs, quality-adjusted life-years (QALYs), any recurrence, recurrence of CIN 1, recurrence of CIN 2/3, number of pap smears, colposcopy, and second LEEP. We assumed that all individuals with any recurrence underwent a colposcopy and that all individuals who had a recurrence of CIN 2/3 would undergo a second LEEP. Probabilities of recurrence were based on a recently-published meta-analysis. All values were derived from the literature and discounted QALYs at a rate of 3%. Utilities were applied for four years after the initial LEEP procedure. Our cost-effectiveness threshold was $100,000/QALY. Univariate sensitivity analyses were performed to evaluate the robustness of the model. Results: In our one-year theoretical cohort of 250,000 patients who had undergone LEEP, the HPV vaccination strategy was associated with 17,281 fewer recurrences of CIN (8,360 cases of CIN 1 and 8,921 cases of CIN 2/3), 26,203 fewer pap smears (1,025,368 vs 1,051,570), 17,281 fewer colposcopies (20,588 vs 37,869), and 8,921 fewer second LEEP procedures (4,779 vs 13,701) (Table 1). The vaccination strategy was associated with a higher cost of $135 million. However, HPV vaccination was the cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $29,180.81. In our sensitivity analyses, the HPV vaccination strategy remained cost-effective until the cost of the 3-dose HPV vaccine series reached $1,899.56, or the baseline (non-vaccinated) probability of recurrence was less than 4.8%. Objectives: Excisional cervical procedures, such as a Cold Knife Cone (CKC) or a loop electrical excision procedure (LEEP), are standard treatments for moderate to severe cervical intraepithelial neoplasia (CIN). Human papillomavirus (HPV) is the causal agent for CIN and can persist or recur; thus, patients can be susceptible to recurrent CIN following excision. Some data suggest that CIN recurrence rates decrease with HPV vaccination after LEEP. Here, we aimed to examine the cost-effectiveness of HPV vaccination following LEEP procedures compared with no vaccination. Methods: We constructed a decision-analytic model (TreeAge Pro 2021) to compare outcomes between patients who underwent LEEP followed by HPV vaccination with those who underwent LEEP without HPV vaccination. Our theoretical cohort contained 250,000 patients, the approximate number of patients who had LEEPs per year in the United States. Our outcomes were costs, quality-adjusted life-years (QALYs), any recurrence, recurrence of CIN 1, recurrence of CIN 2/3, number of pap smears, colposcopy, and second LEEP. We assumed that all individuals with any recurrence underwent a colposcopy and that all individuals who had a recurrence of CIN 2/3 would undergo a second LEEP. Probabilities of recurrence were based on a recently-published meta-analysis. All values were derived from the literature and discounted QALYs at a rate of 3%. Utilities were applied for four years after the initial LEEP procedure. Our cost-effectiveness threshold was $100,000/QALY. Univariate sensitivity analyses were performed to evaluate the robustness of the model. Results: In our one-year theoretical cohort of 250,000 patients who had undergone LEEP, the HPV vaccination strategy was associated with 17,281 fewer recurrences of CIN (8,360 cases of CIN 1 and 8,921 cases of CIN 2/3), 26,203 fewer pap smears (1,025,368 vs 1,051,570), 17,281 fewer colposcopies (20,588 vs 37,869), and 8,921 fewer second LEEP procedures (4,779 vs 13,701) (Table 1). The vaccination strategy was associated with a higher cost of $135 million. However, HPV vaccination was the cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $29,180.81. In our sensitivity analyses, the HPV vaccination strategy remained cost-effective until the cost of the 3-dose HPV vaccine series reached $1,899.56, or the baseline (non-vaccinated) probability of recurrence was less than 4.8%.

The Impact of COVID-19 on Cervical Cancer Screenings and Clinical Outcomes of Patients: A Single-Center Tertiary Healthcare Service Experience

Objective: The COVID-19 pandemic has negatively affected cancer screening activities all over the World. The accumulating data suggest that delayed admissions to screening and clinical assessments are associated with increased morbidity and mortality in cancer. This study aimed to provide data on cervical cancer screenings and clinical outcomescomparatively before and during the pandemic. Method: This study retrospectively compared the demographic and clinical characteristics, screening test results, andcolposcopy assessments of women admitted to the Obstetrics and Gynecology Department of a tertiary-care university hospital before and after March 11, 2020, considered as the date of announcement of the COVID-19 pandemic. Results: A total of 382 patients with a median age of 32 years were included (174 in pre-pandemic and 208 in pandemic periods).In HPV DNA analyses, serotypes reported as high-risk were significantly increased to 22.1%, while others had minor changes in the pandemic. In cytological studies, normal cytology results were significantly decreased to 32.8% from 45.9%, and the ASC-US diagnoses were significantly increased from 12.8% to 27.4%. In addition, the colposcopy examinations revealed that the cold knife cone was increased from zero to 15.3%, routine follow-up was decreased from 88.2% to 71.4%, normal pathologies were decreased from 40.4% to 30.1%, and CIN1 and CIN2 decreased, but CIN3 rose from 3.6% to 6.6%. The HPV DNA and colposcopy follow-up were significantly increased during the pandemic. Conclusions: This study is the first report on the increased numbers of diagnoses of advanced lesions in cervical cancer screenings during the pandemic compared to the pre-pandemic admissions in Turkey. Our results implythe need for immediate actions to normalize cervical cancer screenings to avoid any further morbidity and mortality. High-risk HPV-DNA results in the Covid period were found to be higher than before the Covid period. Keywords: Cervical cancer, screening, cervical smear, cytology, colposcopy, clinical outcomes, COVID-19, pandemic, Turkey

Elevated neutrophil-lymphocyte ratio can be a biomarker for predicting the development of cervical intraepithelial neoplasia.

Cervical intraepithelial neoplasia (CIN) is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. In the present study, we investigated whether measuring the neutrophil-lymphocyte ratio (NLR) can be useful for predicting the risks of developing cervical lesions.This is a retrospective analysis of 212 women who were enrolled in this study. Among them, 106 patients with histologically confirmed CIN1-3 who were treated with loop electrosurgical excision procedure or cold knife cone in the Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University between July 30th 2016 and January 30th 2019.Among the 106 patients in the CIN group, cytology showed minor abnormality which included atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in 42, high-grade squamous intraepithelial lesion in 62, and squamous cell carcinoma in 2 patients. We found that the NLR has no significant difference between the control group and the CIN1 group, while there were significant differences between CIN1 and CIN2, and CIN2 and CIN3 group. The median of the NLR was higher in the HPV16-persistent groups than in the HPV-negative group.In conclusion, a high NLR value independently predicts CIN and the stage of CIN. The NLR may help doctors evaluate outcomes of patients received conization and choose alternative therapies for patients with high NLR value.

Excisional treatment comparison for in situ endocervical adenocarcinoma (EXCISE): A phase 2 pilot randomized controlled trial to compare histopathological margin status, specimen size and fragmentation after loop electrosurgical excision procedure and cold knife cone biopsy

ObjectiveAdenocarcinoma in situ (AIS) of the cervix is a precursor to cervical adenocarcinoma. When AIS is detected by cervical screening an excision biopsy is mandatory to exclude invasion. We aimed to compare margins status, specimen size and fragmentation after loop electrosurgical excision procedure (LEEP) and ‘cold knife cone biopsy’ (CKC). MethodsThe EXCISE Trial was an investigator-initiated, multicenter, open-label, parallel-group, phase 2, randomized study. Patients were enrolled at seven hospitals in Australia and New Zealand. We randomly assigned women aged ≥18 to ≤45 years with screen detected AIS to LEEP or CKC. Co-primary endpoints were margin status, specimen size and fragmentation. Analysis was by intention-to-treat. ResultsBetween August 2, 2017 and September 6, 2019, 40 patients were randomly assigned 2:1 to LEEP or CKC. Margin status was evaluable in 36 cases. The proportion of patients with involved margins did not differ between groups. 25 of 26 LEEP and all 14 CKC biopsies were excised as single specimens (p = 1·00). There were no differences in specimen dimensions. Patients in the CKC group had more post-operative complications (64.3% compared to 15.4% for LEEP p = ·00). There were no differences in grade three complications (p = ·65). ConclusionsLEEP was not associated with a greater likelihood of positive margins, specimen fragmentation or smaller excision compared to CKC when performed according to a standardized protocol. However, the study was not powered to establish non-inferiority of LEEP and a definitive phase 3 trial to compare margin status and rates of treatment failure after LEEP and CKC is warranted.

<u>Ex</u>cisional Treatment  <u>C</u>omparison For  <u>I</u>n  <u>S</u>itu  <u>E</u>ndocervical Adenocarcinoma (EXCISE): A Phase 2 Pilot Randomised Controlled Trial to Compare Histopathological Margins Status, Specimen Size and Fragmentation after Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy

Background: Adenocarcinoma in situ (AIS) of the cervix is a precursor to cervical adenocarcinoma. When AIS is detected by cervical screening an excision biopsy is mandatory to exclude invasion. Two common procedures are loop electrosurgical excision procedure (LEEP) and ‘cold knife cone biopsy’ (CKC), yet no randomised trials have compared these modalities. We aimed to compare margins status, specimen size and fragmentation after LEEP and CKC. Methods: The EXCISE Trial was an investigator-initiated, multicentre, open-label, parallel-group, phase 2, randomised study. Patients were enrolled at seven hospitals in Australia and New Zealand. We randomly assigned women aged ≥18 to ≤45 years with screen detected AIS to LEEP or CKC by computer generated random numbers. Co-primary endpoints were margin status, specimen size and fragmentation. Analysis was by intention-to-treat. Findings: Between August 2, 2017 and September 6, 2019, 40 patients were randomly assigned 2:1 to LEEP or CKC. All patients were included in the analysis. Margin status was evaluable in 36 cases. The proportion of patients with involved margins did not differ between groups. 25 of 26 LEEP and all 14 CKC biopsies were excised as single specimens (p=1.00). There were no differences in specimen dimensions. Patients in the CKC group had more post-operative complications (64.3% compared to 15.4% for LEEP p=.00). There were no differences in grade three complications (p=.65). Interpretation: LEEP was not associated with a greater likelihood of positive margins, specimen fragmentation or smaller excision compared to CKC when performed according to a standardised protocol. However, the study was not powered to establish non-inferiority of LEEP and a definitive phase 3 trial to compare margin status and rates of treatment failure after LEEP and CKC is warranted. Trial Registration: The study is registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR registration number ACTRN12617000132347). Funding Statement: Australia New Zealand Gynaecological Oncology Group [#FNR2016/03]. Declaration of Interests: PAC and CDHW have received honoraria from Seqirus unrelated to this work. All other authors declare no competing interests. Ethics Approval Statement: Ethical approval for the study was granted by the St John of God Healthcare Human Research Ethics Committee (Reference number #1137) and approvals were obtained at all participating sites.

Endocervical adenocarcinoma in situ with ovarian metastasis: a case report

Background: Ovarian metastases, which may simulate primary ovarian neoplasms, can occur in advanced stage primary cervical adenocarcinoma (AC). However, such tumors are very rarely observed in cases of endocervical adenocarcinoma in situ (AIS) with early or even no obvious signs of tumor invasion. Case: We present a case of ovarian metastasis occurring in a 37-year-old triparous premenopausal woman with a diagnosed case of endocervical AIS. The patient presented with a rapidly growing and painful abdominal mass 22 months after a cold knife cone biopsy and 19 months after a simple extrafascial hysterectomy. She was subsequently treated with a combination of surgery and chemotherapy and is currently free of disease seven years after the initial diagnosis of endocervical AIS lacking unequivocally recognizable stromal invasion. Conclusion: Endocervical AIS with early or even no obvious detectable invasion may spread to the ovaries, but this situation is exceptionally rare. We propose that, in such cases, ovary sparing surgery is justifiable for initial treatment. Medical care strategies for patients affected by rare diseases largely depend on experience gained from reported cases in published literature, this is what compelled us to report this particular case.

Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes.

Surgical technique for loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC) emphasizes a uniform specimen, but sequelae of specimen fragmentation are not established. We evaluated outcomes between fragmented and unfragmented excisional biopsy specimens. Loop electrosurgical excision procedure and CKCs from January 2010 to October 2013 were reviewed. Intraepithelial lesion grade, fragmentation, margin, and Endocervical curettage status were analyzed. Adenocarcinoma in situ and cancer were excluded. Repeat procedures during the study period were included in follow-up. Loop electrosurgical excision procedures with top hat with no separate fragments were analyzed independently versus those with fragmented LEEP and/or top hat. Indeterminate margin was defined as inconclusive or unevaluable margin, or intraepithelial lesion in unidentifiable margin or fragment. Outcomes involved residual or recurrent disease and repeat procedures for intraepithelial lesion. χ was used for statistical analysis. Fragmented specimens were more likely to have any positive margin (p = .01), multiple positive margins (p < .001), and indeterminate margin (p < .001) than unfragmented specimens. There was no significant difference in rates of positive, insufficient, or high-grade Endocervical curettage (p = .74, 0.54, 0.92). Patients with fragmented specimens were more likely to have high-grade lesion recurrence in the following 3 years (p = .04) versus patients with index unfragmented specimens, though not compared with those with unfragmented LEEP + top-hat cases. Overall rates of repeat LEEP/CKC or hysterectomy for dysplasia were not different (p = .56). Fragmentation of LEEP and CKC specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial lesions, and indeterminate margins. These may cause diagnostic uncertainty, require closer follow-up, and increase cost with more visits and studies.

REVIEW OF MEDICAL DESCRIPTION OF CERVICAL CYTOLOGY

Cervical cancer is a malignant neoplasm of the cervical area or cervix which may present with the vaginal bleeding but symptoms may be absent until the cancer gets in advanced stage. Dysplasia seen on cervical biopsy uses the term cervical intraepithelial neoplasia (CIN) and is grouped into mild (CIN-1), moderate (CIN-2) and severe (CIN-3). The severity of CIN depends upon cellular disorganization, cellular immaturity, increased mitotic activity and nuclear abnormalities. The nuclear atypia, extent of mitotic activity and immature cellular proliferations identifies the degree of dysplasia. Thus, epithelial thickness which shows differentiation is the useful feature in decision about severity of CIN. Treatment of this cancer may be ablative and/ or excision. Cryotherapy is a reasonable treatment of CIN-1 and CIN-2 but not of CIN-3 which is severe cervical carcinoma. Burning the TZ-transformation zone (Electro diathermy) destroys the tissue more effectively than that of cryotherapy but it usually requires general anesthesia, however laser cold coagulations technique requires local anesthesia usually. Laser TZ Excision compromises the fertility. Knife cone biopsy is used as a preferred treatment for removal of abnormal cervical cells. Now the cone biopsy is generally performed using the laser surgery. Early diagnosis of cervical cancer is very necessary for better control and treatment of it. For early phases of cervical carcinoma, the cryotherapy is very reasonable, however in case of late stage of the disease laser methods are used alone or on combination. Therapy will be termed successful if cytology remains negative after at least six months of its treatment.

Management and long-term outcomes of women with adenocarcinoma in situ of the cervix: A retrospective study.

Adenocarcinoma in situ of cervix is increasingly managed by local excision rather than hysterectomy and this study will ascertain if conservative management by excision alone is adequate. To evaluate the long-term outcomes of conservative management of adenocarcinoma in situ of cervix, particularly in relation to excisional margin status. Retrospective analysis of women diagnosed with adenocarcinoma in situ and their management between 1992 and 2010 retrieved from the Victorian Cervical Cytology Registry, Australia. Failure of conservative treatment is defined by histologically proven adenocarcinoma in situ or adenocarcinoma at follow-up after negative excisional margins. adenocarcinoma in situ of the cervix was managed primarily with cold knife cone biopsy or loop electrosurgical excision of the cervix. Most excisions were in one piece (83.4%) with average depth of 16.1mm and 21.9% had involved excisional margins. Women with adenocarcinoma in situ on any excisional margin were more likely to have residual or recurrent disease (28.7%) compared with negative excisional margins (4.3%). Residual adenocarcinoma in situ was twice as common if adenocarcinoma in situ was present at endocervical (29.6%) and stromal (23.1%) margins compared with an ectocervical margin (13.6%). Cancer incidence at follow-up was 2.3% for women with positive excisional margins compared to 1.3% with negative margins. Women with adenocarcinoma in situ of cervix can be managed with local excisional procedures, best in single pieces to provide the important information on excisional margins. Adenocarcinoma in situ at endocervical and stromal excisional margins needs re-excision or where appropriate, hysterectomy, while negative excisional margins have a low rate of recurrence and can be followed up with test of cure.

Cervical Adenocarcinoma: Histopathologic Features From Biopsies to Predict Tumor Behavior.

The pattern-based classification system of endocervical adenocarcinoma correlates with nodal metastasis and clinical outcomes, but its application in biopsies is challenging. The aim of this study was the correlation of additional histologic features with patterns of invasion as well as prognosis. A total of 103 specimens from 71 cervical adenocarcinoma cases were studied. Among the 71 cases, all had resection specimens including hysterectomy, cold knife cone excision or loop electrosurgical excision procedure excision, and 32 of these had prior cervical biopsies. We applied the pattern-based classification system to all the specimens and evaluated histopathologic features microscopically. Findings in biopsies were compared with their corresponding resections and correlated with nodal status and disease stage. In 71 resection specimens, pattern A was present in 10 (14.1%), pattern B in 12 (16.9%), and pattern C in 49 (69%) cases. Of the 32 cervical biopsies, pattern of invasion could be classified in only 16 (50%) cases, including 1 (6%) with pattern A, 4 (25%) with pattern B, and 11 (69%) with pattern C. Of the 32 cervical biopsies, 30 could be evaluated for intraluminal necrotic/tumor debris and/or grade 3 nuclei, which correlated with pattern C as well as with lymph node metastasis in the subsequent staging specimens. No tumor with patterns A or B had intraluminal necrotic/tumor debris or grade 3 nuclei in either biopsy or resection specimens. Therefore, intraluminal necrotic/tumor debris and grade 3 nuclei are highly predictive histologic features for cervical adenocarcinomas with pattern C invasion and nodal metastasis.

Comparative efficacy and complication rates after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE Group

IntroductionLocal treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques...

Oncological and Reproductive Outcomes of Adenocarcinoma in situ of the Cervix Managed with the Loop Electrosurgical Excision Procedure

The standard treatment for cervical adenocarcinoma in situ (AIS) is hysterectomy, which is a more aggressive treatment than that used for squamous intraepithelial lesions. Several previous studies have primarily demonstrated that the loop electrosurgical excision procedure (LEEP) is as safe and effective as cold knife cone (CKC) biopsy when AIS is unexpectedly found in a loop excision. This study evaluated the safety of LEEP as the initial treatment for patients with AIS who were strictly selected and evaluated before and after loop resection. The oncological and reproductive outcomes of a series of AIS patients who underwent LEEP as the initial treatment between February 2006 and December 2016 were retrospectively evaluated. A total of 44 women were eligible for analysis. The mean age at diagnosis was 36.1 years, and 14 patients were nulliparous. Multiple lesions were identified in 4 (9.1%) patients. Either hysterectomy (6 patients) or repeat cone biopsies (3 patients) were performed in 8 of the 10 patients who presented positive or not evaluable surgical resection margins (SMs) on the initial LEEP specimens. Residual disease was detected in two patients. All patients were closely followed for a mean of 36.9 months via human papillomavirus testing, PAP smears, colposcopy, and endocervical curettage when necessary. No recurrences were detected. Of the 16 patients who desired to become pregnant, 8 (50%) successfully conceived, and the full-term live birth rate was 83.3% among this subgroup. LEEP with negative SMs was a safe and feasible fertility-sparing surgical procedure for patients with AIS, and the obstetric outcome was satisfactory. However, long-term follow-up is mandatory.

Specimen fragmentation and outcomes of loop electrosurgical excision procedures (LEEP) and cold knife cone biopsies (CKC) for cervical dysplasia at a large, underserved public hospital

Specimen fragmentation and outcomes of loop electrosurgical excision procedures (LEEP) and cold knife cone biopsies (CKC) for cervical dysplasia at a large, underserved public hospital

Oncological and reproductive outcomes of adenocarcinoma in situ of the cervix managed with the loop electrosurgical excision procedure

BackgroundThe standard treatment for cervical adenocarcinoma in situ (AIS) is hysterectomy, which is a more aggressive treatment than that used for squamous intraepithelial lesions. Several previous studies have primarily demonstrated that the loop electrosurgical excision procedure (LEEP) is as safe and effective as cold knife cone (CKC) biopsy when AIS is unexpectedly found in a loop excision. This study evaluated the safety of LEEP as the initial treatment for patients with AIS who were strictly selected and evaluated before and after loop resection.MethodsThe oncological and reproductive outcomes of a series of AIS patients who underwent LEEP as the initial treatment between February 2006 and December 2016 were retrospectively evaluated.ResultsA total of 44 women were eligible for analysis. The mean age at diagnosis was 36.1 years, and 14 patients were nulliparous. Multiple lesions were identified in 4 (9.1%) patients. Either hysterectomy (6 patients) or repeat cone biopsies (3 patients) were performed in 8 of the 10 patients who presented positive or not evaluable surgical resection margins (SMs) on the initial LEEP specimens. Residual disease was detected in two patients. All patients were closely followed for a mean of 36.9 months via human papillomavirus testing, PAP smears, colposcopy, and endocervical curettage when necessary. No recurrences were detected. Of the 16 patients who desired to become pregnant, 8 (50%) successfully conceived, and the full-term live birth rate was 83.3% among this subgroup.ConclusionsLEEP with negative SMs was a safe and feasible fertility-sparing surgical procedure for patients with AIS, and the obstetric outcome was satisfactory. However, long-term follow-up is mandatory.

A Case of Human Papilloma Virus 31- and 68-Associated Metastatic Squamous Cell Carcinoma of the Cervix in a Healthy 28-Year-Old Woman

Background: Cervical cancer is often a slowly progressing malignancy that presents in women with a mean age of 51. This case is a highly unusual presentation of metastatic squamous cell carcinoma (SCC). Case: A 28-year-old healthy, gravida 0, female—who was post a quadrivalent Gardasil® series with normal Papanicolaou smears—presented with abdominal pain, bloating, and postcoital bleeding. A colposcopy was significant for cervical intraepithelial neoplasia III. Cold knife cone was significant for SCC with positive margins. Human papilloma virus (HPV) typing was positive for HPV 31 and 68. Positron emission tomography was negative for metastasis. However, a radical hysterectomy started and then was abandoned due to the discovery of metastases to the sigmoid epiploica. Results: Pathology testing revealed that this patient had SCC with metastasis to the sigmoid epiploica and to 2 pelvic lymph nodes. Immunohistochemical staining was positive for p16. She was diagnosed with stage IVA SCC of the cervix and, as of this writing, stated that she intended to undergo radiation therapy followed by chemotherapy. Conclusions: When appropriate, a high index of suspicion is necessary to diagnose cervical cancer in low-risk individuals. (J GYNECOL SURG 34:159)

Выбор геометрических параметров инструмента для малоотходной безуклонной горячей объёмной штамповки воротниковых фланцев методом “раздача-выдавливание”

In the course of computer modeling based on the DEFORM 3D software package, an experiment was conducted to determine the optimal parameters of the tool for the distribution-extrusion process. The simulation was performed by varying the cone angle of the knife, as well as by changing the conditions of contact friction. The satisfactory geometrical parameters of the knife cone, namely, the deflection angle (10 0 ) and the coefficient of friction (0.25), are determined. The simulation was carried out on the model of forging the collar flange 50-16-11-1-B. The definition of the above parameters will optimize the process of forming, eliminating the calibration operation