Laser Conization Research Articles

Conservative Treatment of Stage IA1 Adenocarcinoma of the Cervix During Pregnancy

Glandular neoplasms of the uterine cervix have become increasingly prevalent in the past 2 decades and tend to develop in women of childbearing age, raising the question of whether conservative management can be effective. Recent studies support cervical conization for use in treating adenocarcinoma-in-situ as long as the margins of the cone are clear. This study presents the preliminary results of treating FIGO (International Federation of Gynecology and Obstetrics) stage IA1 cervical adenocarcinoma by cervical conization in 16 pregnant women, 4 of whom were diagnosed during pregnancy. Four pregnant women 29-37 years of age underwent KTP LASER conization and vaporization of the lesion at 16-23 weeks' gestation. All of these tumors were endocervical type adenocarcinomas not associated with lymph-vascular space invasion. These women strongly wished to continue their pregnancies. None of them had excessive blood loss or premature labor and there were no miscarriages. The cone specimens exhibited microinvasive adenocarcinoma with 0.7-2.0 mm of stromal invasion. Two of these patients had invasive cancer at the cone margin and underwent a second conization, one at 20 weeks' gestation and one at 5 weeks after delivery. The second cone specimens were free of disease. All 4 women delivered at term, 2 vaginally and 2 by cesarean section. One patient was treated subsequently only by cervical conization, while 3 had extended radical hysterectomy with pelvic node dissection following delivery. No patient had residual invasive cancer in a subsequent surgical specimen, and none of them developed recurrent disease during follow-up for at least 2 years and for as long as 13 years.

Conservative treatment of stage IA1 adenocarcinoma of the cervix during pregnancy

Objective The incidence of glandular neoplasms of the uterine cervix has been steadily increasing over the past 2 decades. These lesions tend to arise in women of childbearing age. Few reports have described the treatment of glandular neoplasms of the cervix in gravid women. This report describes the preliminary results of treating stage IA1 cervical adenocarcinoma by cervical conization during pregnancy. Methods All patients diagnosed to have FIGO stage IA1 cervical adenocarcinoma between 1990 and 2006 were reviewed and patients diagnosed during pregnancy were identified. Information was abstracted on the clinical data including the presence or absence of disease at the margins of conization, pregnancy outcome, and the follow-up. Results Sixteen patients with stage IA1 cervical adenocarcinoma were identified. Four out of the 16 patients were diagnosed during pregnancy. Four women ages 29–37 underwent KTP LASER conization and vaporization at 16 to 23 weeks' gestation. The histology showed that all of the tumors were endocervical type adenocarcinoma. None had lymph-vascular space invasion. All of these patients expressed a strong desire to continue their pregnancy. Two patients had positive conization margins for invasive cancer and underwent a second conization at 20 weeks' gestation and 5 weeks after delivery, respectively. No residual disease was identified in the second conization specimens. All patients delivered at term. One patient was treated with cervical conization alone and 3 patients were treated with an extended radical hysterectomy with pelvic lymph nodes dissection after delivery. No patient had residual invasive cancer in a subsequent surgical specimen. None of the patients had developed recurrent disease after a 2–13-year follow-up. Conclusion These preliminary data suggest that patients with FIGO stage IA1 cervical adenocarcinoma may be treated conservatively by cervical conization during pregnancy. Although a hysterectomy should be considered at the completion of childbearing, fertility sparing postpartum management could be an option for selected patients.

PCR detection rates of high risk human papillomavirus DNA in paired self-collected urine and cervical scrapes after laser CO2 conization for high-grade cervical intraepithelial neoplasia

Objective To compare the PCR detection rates of high risk human papillomavirus DNA in self-collected urine and cervical scrapes during follow-up of patients treated for HG-CIN by laser CO2 conization. Patients and methods 52 women who submitted to laser conization for HG-CIN were enrolled into this prospective follow-up study receiving liquid-based cytology and HR-HPV testing by PCR assay on self-collected urine and cervical scrapes before and at 3, 6 and 12 months after treatment. Diagnostic accuracy and predictive values for treatment failure were evaluated for both urinary and cervical HPV testing and follow-up cytology. Results 3 cases (5.8%) of recurrent HG-CIN occurred during follow-up. Positive margins and HR-HPV persistence resulted to significant risk factors for recurrence ( p = 0.01). The overall concordance on HR-HPV detection between paired urine and cervical samples was 96.6% and discord trend between agreement rates during follow-up were excluded by overall fixed-effect index (OR 1.03; 95% CI 0.62–1.70). No difference was observed comparing the three- and six-month cumulative sensitivity and NPV for recurrent disease of urinary and cervical HPV detections, with an increase of 5.6% in specificity associated with urinary testing. Conclusions PCR detection of HR-HPV in paired urine and cervical samples during follow-up revealed an excellent concordance, suggesting a potential equivalent role of the two methods within post-treatment follow-up. In our experience HPV testing on self-collected urine was more sensitive than cytology and more specific than cervical HPV detection to predict treatment failure. Larger studies are needed to definitively establish the role of urine-based HPV testing during follow-up.

Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis

Objective To assess the relative risk of perinatal mortality, severe preterm delivery, and low birth weight associated with previous treatment for precursors of cervical cancer.Data sources Medline and Embase citation...

Pregnancy-related complications after vaginal radical trachelectomy for early-stage invasive uterine cervical cancer

Pregnancy-related complications after vaginal radical trachelectomy (RT) for early-stage invasive uterine cervical cancer were studied in comparison with those occurring after laser conization. The strategy to reduce vaginal RT-related complications during pregnancy is also discussed. Pregnancy courses after vaginal RT in two patients and those after laser conization in five patients, whose operations were performed during the same period, were studied with respect to symptoms, cervical length, and infectious signs. The cervix shortened progressively both in patients with laser conization and in those with RT. However, throughout the pregnancy, the remaining cervix after the operation was longer in patients who had undergone conization than in those who had undergone vaginal RT. After laser conization, two of the five patients suffered from preterm rupture of the membrane (PROM) at 36 weeks of gestation, and both patients who had undergone vaginal RT had premature PROM (pPROM), at 32 and 24 weeks of gestation, respectively. Prevention of preterm labor and the following occurrence of pPROM is a significant task to be resolved in order to improve pregnancy outcome after vaginal RT for early-stage invasive uterine cervical cancer. Daily vaginal disinfection with povidone iodine and the administration of a ulinastatin vaginal suppository, bed rest, and the use of ritodrine would be the best approach, and a more conservative approach for stage Ia2 also might be taken into consideration.

Pregnancy outcome after cervical cone excision: a case‐control study

To investigate the effect of cervical laser conisation (CLC) or loop electrosurgical excision procedure (LEEP) on the outcome of subsequent pregnancies. Methods. Multi-centre, retrospective, case-control study, which included a cohort of 742 women, who, after treatment with LEEP or CLC, gave birth or suffered second trimester miscarriage. Control women (n=742) were extracted from the respective hospital birth registries and matched by age and parity. Outcome measures were perinatal mortality, length of gestation, birth weight and preterm premature rupture of membranes (pPROM). There was no significant difference in perinatal mortality among women treated with LCL or LEEP compared to controls, 6/742 versus 2/742: odds ratio (OR)=3.1 (95% CI: 0.6-15.2). Excluding second trimester miscarriages, ORs for giving birth before week 37, 32 and 28 after conisation compared to the controls were 3.4 (95% CI: 2.3-5.1), 4.6 (95% CI: 1.7-12.5), and 12.4 (95% CI: 1.6-96.1), respectively, after adjusting for smoking habits during pregnancy, marital status and educational level. Adjusted ORs of birth weight <2,500, <1,500 and <1,000 g after conisation compared to controls were 3.9 (95% CI: 2.4-6.3), 4.4 (95% CI: 1.5-13.6), and 10.4 (95% CI: 1.3-82.2), respectively. The adjusted OR for pPROM was 10.5 (95% CI: 3.7-29.5). Treatment by CLC and LEEP increases the risk of preterm delivery, low birth weight and pPROM in subsequent pregnancies.

Clinical efficacy of conservative laser therapy for early-stage cervical cancer

The objective of this study was to evaluate the clinical efficacy of conservative laser therapy for early-stage cervical cancer. Seven hundred fifty-two and 271 patients with carcinoma in situ (CIS) and microinvasive squamous cell carcinoma (MIC), respectively, were treated by laser conization with vaporization. One hundred eighty-four patients with preclinical invasive diseases underwent radical surgery without conization. Their postoperative histologic findings and clinical outcomes were evaluated retrospectively. The cone specimens of 1023 cases were reported as showing that 54 had dysplasia, 663 had CIS, 239 had stage Ia1 without lymph vascular space invasion (LVSI), 14 had stage Ia1 with LVSI, 14 had stage Ia2, and 39 had stage Ib1 diseases. Incomplete excision occurred in 4 (7.4%) of 54 dysplasia, 48 (7.2%) of 663 CIS, and 16 (6.7%) of 239 stage Ia1 cases, but failure rates were only 1 (1.9%), 8 (1.2%), and 4 (1.7%), respectively. The other 67 of 1023 cases underwent abdominal operation. Final pathology results were analyzed for 67 and 184 cases with stages Ia1 to Ib1 receiving radical surgery with or without initial laser therapy. Lymph node metastasis was not observed in 154 Ia1 and 30 Ia2 with stromal invasion of under 4 mm in depth regardless of LVSI, but was detected in 2 of 16 Ia2 with stromal invasion of over 4 mm in depth and in 9 of 51 Ib1 cases. CIS and Ia1 disease without LVSI can be treated only by laser therapy. The limit of stromal invasion for conservative laser therapy in stage Ia cancer may be 4 mm in depth regardless of LVSI.

Diagnostic and Therapeutic Laser Conization for Cervical Intraepithelial Neoplasia

Numerous studies-some of them randomized-have failed to find major differences in cure rates of cervical intraepithelial neoplasia (CIN) among cryotherapy, laser treatment, and loop electrosurgical excision. The investigators have, in the past 2 decades, treated CIN in 2107 women by gadolinium (Nd-YAG) laser conization that vaporized the base. The procedure took only 12 minutes on average. Just over 10% of women lost more than 20 mL of blood during the procedure. Approximately 7% of patients, 98% of them postmenopausal, had cervical obstruction during follow up. Either no CIN or grade 1-3 CIN was found in 92.8% of cone specimens, whereas 7.2% exhibited invasive disease. Women lacking invasive disease were followed between 16 months and 21 years. The rate of incomplete excision was 12.3% in patients having CIN in the cone specimen, but the rate of persistent or recurrent disease was only 1.2%. Of 230 patients with postoperative CIN and positive surgical margins, 83.5% had no abnormal cytologic or colposcopic abnormalities during follow up. In contrast, preoperative underdiagnosis of the biopsy results did increase the risk of incomplete excision and failure. The odds ratio for incomplete excision was 1.51 (95% confidence interval [CI], 1.13-2.02) and that for failure was 3.20 (95% CI, 1.44-7.13). Combining laser conization with vaporizing the base is an effective means of treating CIN because it detects otherwise unexpected invasive disease.

Successful delivery after vaginal radical trachelectomy for invasive uterine cervical cancer

A 32-year-old Japanese woman was diagnosed as having stage Ib1 adenocarcinoma by diagnostic laser conization at a local hospital. She was admitted to our hospital for fertility-sparing treatment. A radical trachelectomy (RT) was performed using the laparoscopic vaginal procedure. The procedure was started with a laparoscopic pelvic lymphadenectomy. As the lymph nodes were tumor free, RT was carried out transvaginally. The excised uterine cervix and lymph nodes were pathologically negative for cancer. Eight months after the operation, the patient became pregnant without any artificial reproduction techniques. At 17 weeks of gestation, she was admitted to our hospital again for a threatened abortion. Continuous tocolytic treatment with ritodrine and daily administration of a granulocyte elastase inhibitor vaginal suppository were given. At 32 weeks of gestation, she underwent emergency cesarean section because of sudden premature rupture of the membranes. A girl weighing 1991 g was delivered, with Apgar scores of 7 and 8 at 1 and 5 min, respectively. Both the mother and the baby were discharged without trouble. This is the first successful case in Japan of delivery after vaginal RT for invasive uterine cervical cancer.

Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis

Conservative methods to treat cervical intraepithelial neoplasia and microinvasive cervical cancer are commonly used in young women because of the advent of effective screening programmes. In a meta-analysis, we investigated the effect of these procedures on subsequent fertility and pregnancy outcomes. We searched for studies in MEDLINE and EMBASE and classified them by the conservative method used and the outcome measure studied regarding both fertility and pregnancy. Pooled relative risks and 95% CIs were calculated with a random-effects model and interstudy heterogeneity was assessed with Cochrane's Q test. We identified 27 studies. Cold knife conisation was significantly associated with preterm delivery (<37 weeks; relative risk 2.59, 95% CI 1.80-3.72, 100/704 [14%] vs 1494/27 674 [5%]), low birthweight (<2500 g; 2.53, 1.19-5.36, 32/261 [12%] vs 905/13 229 [7%]), and caesarean section (3.17, 1.07-9.40, 31/350 [9%] vs 22/670 [3%]). Large loop excision of the transformation zone (LLETZ) was also significantly associated with preterm delivery (1.70, 1.24-2.35, 156/1402 [11%] vs 120/1739 [7%]), low birthweight (1.82, 1.09-3.06, 77/996 [8%] vs 49/1192 [4%]), and premature rupture of the membranes (2.69, 1.62-4.46, 48/905 [5%] vs 22/1038 [2%]). Similar but marginally non-significant adverse effects were recorded for laser conisation (preterm delivery 1.71, 0.93-3.14). We did not detect significantly increased risks for obstetric outcomes after laser ablation. Although severe outcomes such as admission to a neonatal intensive care unit or perinatal mortality showed adverse trends, these changes were not significant. All the excisional procedures to treat cervical intraepithelial neoplasia present similar pregnancy-related morbidity without apparent neonatal morbidity. Caution in the treatment of young women with mild cervical abnormalities should be recommended. Clinicians now have the evidence base to counsel women appropriately.

Diagnostic and therapeutic laser conization for cervical intraepithelial neoplasia

Objective.The clinical efficacy of conservative treatment using Nd-YAG laser technique for cervical intraepithelial neoplasia (CIN) was evaluated in a large series of CIN patients based on the long-term follow-up results. Methods.We have treated 2107 women preoperatively diagnosed as having CIN by Nd-YAG contact laser conization with vaporization of the base. Their postoperative histologic findings and clinical outcomes were evaluated. Results.The cone specimen was reported as showing that 1956 (92.8%) of 2107 cases had no CIN or CIN 1–3 and 151 (7.2%) cases had invasive diseases. 1956 cases without invasive diseases were followed up for 16 to 252 months. Incomplete excision occurred in 230 (12.3%) of 1874 patients with CIN lesion in the cone specimen, but failure rate (persistence or recurrence) was only 1.2%. 192 (83.5%) of 230 postoperative CIN patients with positive surgical margins showed no abnormal cytology or colposcopy during follow-up period. Preoperative underdiagnosis of biopsy results compared with cytologic or colposcopic findings elevated the risk for incomplete excision and failure rate. Conclusion.The combination of laser excision and vaporization of the base was useful to detect unexpected invasive disease and revealed excellent therapeutic effects for CIN. Preoperative cytologic or colposcopic findings should be taken into account for the conservative treatment of CIN.

Is laser conization adequate for therapeutic excision of adenocarcinoma in situ of the uterine cervix?

To determine the safety of uterine-preserving operations for adenocarcinoma in situ of the cervix. Fifteen cases of adenocarcinoma in situ (AIS) were diagnosed using neodymium:yttrium aluminum garnet (Nd:YAG) laser conization. The accuracy of preconization histology or cytology was evaluated in 15 AIS cases. In these AIS cases, we investigated how far the tumor was located from the squamocolumnar junction (SCJ) and the endocervix. Fourteen cases of the 15 AIS-affected patients were treated using laser conization alone. These patients were closely followed up. Precise agreement between preconization diagnosis and conization histology was seen in 46.7% (7/15) of the AIS cases. In 14 of the 15 cases of AIS (93.3%), the tumor was adjacent to the transitional zone, within 3 mm of the SCJ, and in the other case (6.7%), the tumor was between 0 and 5 mm away from the SCJ. In all subjects, cone height was 8-18 mm (mean 13.1 mm). None of the 15 patients showed any recurrence of AIS during follow up ranging from 15 to 75 months (43.1 months on average). Women with AIS who want to preserve their fecundity might be treated with laser conization alone.

Laser CO 2 conization in postmenopausal age: risk of cervical stenosis and unsatisfactory follow-up

Objective To assess chances of adequate cyto-colposcopic follow-up after laser conization performed in postmenopausal screening population by the evaluation of postoperative cervical stenosis and unsatisfactory colposcopy rates. Patients and methods One thousand two hundred eighteen patients were submitted to laser CO 2 conization for cervical intraepithelial neoplasia (CIN). Incidence and risk factors for cervical stenosis and unsatisfactory follow-up were retrospectively evaluated comparing fertile with postmenopausal patients. Results Global incidences of postoperative unsatisfactory colposcopy and cervical stenosis were 46.2% and 7.1%. These rates were higher in postmenopausal patients compared with fertile ones, revealing a statistical correlation between unsatisfactory follow-up and postmenopausal status at the time of conization. Association between CIN relapse and cervical stenosis was significantly higher in postmenopausal group (66.7% vs. 8.6%; P < 0.05), where two cases of recurrence were detected only after hysterectomy, because of an insurmountable cervical stenosis. Univariate and multivariate analysis revealed HRT use as the only significant factor in influencing postoperative cervical stenosis. Conclusion Conization is still considered as the standard treatment for CIN at any woman's age, when excisional management is indicated, but all postmenopausal patients should be counseled about the possibility of postoperative stenosis that could exclude an adequate follow-up, configuring a failure of the conservative treatment. HRT use is associated with a low risk of stenotic complications; therefore, if possible, users should be encouraged to continue therapy at least 1 year after laser conization.

Recent work on the epidemiology of preterm birth

Preterm birth proportions and outcomes are strongly influenced by the criteria for inclusion of births and deaths in national data systems and Registers. The European Commission Health Monitoring Program includes development of indicators to monitor and evaluate perinatal health, and a recent journal supplement provides results from this PERISTAT project. The analysis by subgroups of gestational age, birthweight, and plurality, shown in the supplement (1), demonstrates the impact of these registration differences. The second development is the recognition that the analysis of preterm birth and fetal and infant deaths would best be thought of as occurring within a cohort of conceptions which reach 20 weeks gestation (2). All those still in utero are at risk of being born in any given week. This approach has already provided an explanation for the paradox of intersecting perinatal mortality curves between babies of smokers and non-smokers, and between singleton and twin infants (2, 3). One research group has carried out a series of systematic reviews of the accuracy of methods for predicting preterm birth, either in threatened preterm labor or among asymptomatic women. Their review of published risk-scoring systems found that none could be recommended (4). A systematic review of controlled studies of perinatal outcomes for singletons and twins after assisted conception concluded that singletons had a significantly worse outcome than non-assisted singletons: the relative risk (RR) was 3.27 [95% confidence interval (CI) 2.03–5.28] for birth <32 weeks and 2.04 (95% CI 1.80–2.32) for any preterm birth. There were no differences in preterm birth between assisted and unassisted twin births (5). Evidence that intimate partner violence (IPV) is a major risk factor for preterm birth has been strengthened. IPV reported to police during pregnancy was followed by a large increase in births before 32 weeks [adjusted odds ratio (aOR) 3.71, 95% CI 1.80, 7.63) and 1.61 (95% CI 1.14, 2.28) for any preterm birth (6). A large population-based study found an increased risk of antepartum hemorrhage [aOR 3.79 (95% CI 1.38, 10.4)] and even larger odds of perinatal death [8.06 (95% CI 1.42, 45.6)] (7). The large European case–control study (EUROPOP) found no excess risk of preterm birth among women employed in pregnancy, but an increased risk for women working more than 42 hr a week, standing more than 6 hr a day, and among those with low job satisfaction (8). The possibility of longer term effects has been demonstrated most clearly by the association of a prior cesarean birth with antepartum hemorrhage and placenta praevia, both risks for preterm birth (9). An analysis of linked records from first and second births in Scotland using the fetuses-at-risk approach showed other adverse effects of prior cesarean, including an increased risk of late preterm birth (33–36 weeks) and fetal death at and after 34 weeks (10). EUROPOP took advantage of different patterns of abortion use in three groups of countries to measure a significant association of prior abortion with preterm birth in all three groups. The risk increased with the number of prior abortions and was larger for very preterm birth. The clinical pathways to preterm birth were spontaneous preterm labor, preterm PROM, and antepartum hemorrhage (11) Records of women with cervical dysplasia were linked to subsequent births in New Zealand to compare preterm birth in those treated and untreated. An increase in preterm PROM was seen with the loop electrosurgical excision procedure and laser conization, though not with laser ablation, and the risk increased with the height of tissue removed (12). The findings were not assessed against population-based data. These three examples demonstrate the need for a broader approach to thinking about epidemiology, etiology, and pathways to preterm birth.

Treatment for Cervical Intraepithelial Neoplasia and Risk of Preterm Delivery

Effective treatment of cervical intraepithelial neoplasia (CIN) can prevent invasive cervical cancer. The trend away from cold-knife conization toward more conservative procedures continues, but it is possible that excisional or ablative treatments might increase the risk of preterm delivery by lessening the mechanical support lent by a shortened cervix. These procedures also could impair local immunity by destroying glandular epithelium, and they might alter the bacterial flora in the cervicovaginal region. This retrospective cohort study, carried out at a colposcopy clinic in Auckland, New Zealand in the years 1988-2000, compared delivery outcomes in 652 women treated for CIN by laser conization, laser ablation, or a loop electrosurgical excision procedure (LEEP) and 426 untreated women. All participants carried a singleton pregnancy to at least 20 completed weeks of gestation. The overall rate of preterm delivery (before 37 weeks gestation) was 13.8%. The most common cause, identified in 45% of cases, was premature rupture of membranes (pPROM). Rates of total pretrerm deliveries, pPROM, and spontaneous preterm labor were higher in treated than in untreated women. Preterm delivery was iatrogenic in 2.9% of the treated group and 5.2% of the untreated group. Adjusted relative risk (aRR) figures showed that treating CIN was not associated with an increased risk of total or spontaneous preterm deliveries, but a single laser conization treatment or LEEP was associated with an increased risk of pPROM leading to preterm delivery. The risk of pPROM increased with an increasing height of excised cervical tissue. Women with a vertical cone height of at least 1.7 cm of tissue removed had a greater than 3-fold increase in risk of preterm delivery compared with untreated women (aRR, 3.6). The risk of pPROM increased linearly with increasing cone height; no threshold value was identified. The risk of all preterm deliveries increased significantly with increasing cone height. Treatment variables did not interact significantly with age, parity, or smoking during pregnancy, Mode of treatment did not relate to cone height. Women who are aware of the risk of preterm delivery associated with treating CIN will be likelier to present at an early stage for antibiotic and steroid treatment. Cervical cerclage might have a role in managing women whose ultrasound studies show progressive cervical shortening during pregnancy.

Conservative excisional laser conization for early invasive cervical cancer

Objective.To investigate the possibility of conservative excisional laser conization for early invasive cervical cancer. Methods.Four hundred one women with early invasive squamous cell cancer were treated by laser conization and semiradical or radical hysterectomy with pelvic lymphadenectomy. Their histologic findings and clinical outcomes were evaluated retrospectively. Results.Two hundred Ia1 cases without confluent invasion or vessel permeation receiving only laser therapy had no recurrent disease. There was no lymph node metastasis in 123 Ia1 and 24 Ia2 cases with stromal invasion of under 4 mm in depth regardless of confluent invasion and vessel permeation. However, lymph node metastasis was detected in 1 of 13 Ia2 cases with stromal invasion of over 4 mm in depth and in 5 of 41 Ib1 cases. All of these six cases had vessel permeation in the resected specimens. Conclusion.Conservative excisional laser conization may be possible for stage Ia cervical cancer with stromal invasion of under 4 mm in depth. However, the risk of lymph node metastasis should be still considered for those lesions with vessel permeation.

Eradication of HPV post-surgical treatments, its correlation with specific types, types of surgery and the physical status

Low-risk human papillomaviruses (HPVs) will be completely eradicated as long as most visible lesions are treated. However, it is uncertain whether this is also the case for high-risk HPVs that are capable of causing cervical cancer. Many recent studies have demonstrated a high incidence of HPV persistence during post-conization or loop electrosurgical excision (LEEP) due to high-grade cervical intraepithelial neoplasia (CIN). In this report, we correlated the post-operative HPV status with pre-operative HPV type, types of surgery and HPV's physical status. Post-operative HPV E6 amplification by nested PCR was carried out for 157 female patients with positive pre-operative HPV. They underwent LEEPs, therapeutic laser conizations, and simple or radical hysterectomies. We found that high-risk types of HPVs were eradicated in 26.4% (42/159) of patients after extirpation of the lesions. The clearance rate of HPVs increased to 39.2% (40/102), excluding patients with other high-risk (OHR) kinds of type 31, 52b and 58, since OHR persisted after almost all surgeries. Eradication of HPV after radical hysterectomies are highly expected for patients with invasive cancer (70.0%, when excluding OHR), while more than half of them with CIN continue to carry pre-operative types of HPV or some different types from before treatment. Type 33 is most frequently persistent among types 16, 18 and 33. Persistent high-risk HPVs increase the risk for recurrence of post-surgical treatments of CIN, but the incidence is not high as long as the lesion is completely removed.

Prognosis and efficacy of fertility spearing treatment for early stage uterine cervical cancer (CxCa)

5130 Background: Patients with early stage CxCa and who desire to spare fertility should be offered uterine spearing treatment. Cervical conization therapy has been shown to be good prognosis for early stage CxCa and efficacy for fertility spearing. Methods: Sixty patients with CxCa (stage 0=59, 1a1=1) received carbon dioxide laser conization therapy between 1994 and 2003. Thirty four patients have received cervical conization therapy during or before pregnant. One pregnant was twin. Cases were matched one-to-one with controls for known risk factors for preterm delivery. The pregnant outcome measures were pregnancy duration, rate of preterm delivery, mode of delivery, low birth weight infants, apgar score (APS) and infants abnormalities. Results: None of the patients with early stage CxCa treated with cervical conization have developed recurrent disease (8–107 months, average 45 months). Thirty three women with singletone pregnancies received cervical conization therapy and 33 controls were included in this study. No difference was found in the rate of duration of pregnancy, preterm delivery, mode of delivery, low birth weight infants, apgar score (APS) and infants abnormalities. Especially, infants from patients received cervical conization therapy were all appropriate for dates, high APS and with no abnormalities. Conclusions: Patients with early stage CxCa treated by cervical conization therapy had good prognosis. The risk of prematurity and infants abnormalities did not increase after carbon dioxide laser conization therapy for early stage CxCa. No significant financial relationships to disclose.

Prognosis and efficacy of fertility spearing treatment for early stage uterine cervical cancer (CxCa)

5130 Background: Patients with early stage CxCa and who desire to spare fertility should be offered uterine spearing treatment. Cervical conization therapy has been shown to be good prognosis for early stage CxCa and efficacy for fertility spearing. Methods: Sixty patients with CxCa (stage 0=59, 1a1=1) received carbon dioxide laser conization therapy between 1994 and 2003. Thirty four patients have received cervical conization therapy during or before pregnant. One pregnant was twin. Cases were matched one-to-one with controls for known risk factors for preterm delivery. The pregnant outcome measures were pregnancy duration, rate of preterm delivery, mode of delivery, low birth weight infants, apgar score (APS) and infants abnormalities. Results: None of the patients with early stage CxCa treated with cervical conization have developed recurrent disease (8–107 months, average 45 months). Thirty three women with singletone pregnancies received cervical conization therapy and 33 controls were included in this study. No difference was found in the rate of duration of pregnancy, preterm delivery, mode of delivery, low birth weight infants, apgar score (APS) and infants abnormalities. Especially, infants from patients received cervical conization therapy were all appropriate for dates, high APS and with no abnormalities. Conclusions: Patients with early stage CxCa treated by cervical conization therapy had good prognosis. The risk of prematurity and infants abnormalities did not increase after carbon dioxide laser conization therapy for early stage CxCa. No significant financial relationships to disclose.

Treatment for cervical intraepithelial neoplasia and risk of preterm delivery.

It is unclear whether treatments for cervical intraepithelial neoplasia (CIN) increase the subsequent risk of preterm delivery. Most studies have lacked sufficient sample size, mixed heterogeneous subtypes of preterm delivery, and failed to control for confounding factors. To determine whether cervical laser and loop electrosurgical excision procedure (LEEP) treatments increase risk of preterm delivery and its subtypes. Retrospective cohort study conducted among women evaluated at a colposcopy clinic serving Auckland, New Zealand (1988-2000), comparing delivery outcomes of untreated women (n = 426) and those treated (n = 652) with laser conization, laser ablation, or LEEP. Record linkage using unique health identifiers identified women who had subsequent deliveries. Total preterm delivery and its subtypes, spontaneous labor and premature rupture of membranes before 37 weeks' gestation (pPROM). The overall rate of preterm delivery was 13.8%. The rate of pPROM was 6.2% and the rate of spontaneous preterm delivery was 3.8%. Analyses showed no significant increase in risk of total preterm delivery (adjusted relative risk [aRR], 1.1; 95% confidence interval [CI], 0.8-1.5) or spontaneous preterm delivery (aRR, 1.3; 95% CI, 0.7-2.6) for any treatment. Risk of pPROM was significantly increased following treatment with laser conization (aRR, 2.7; 95% CI, 1.3-5.6) or LEEP (aRR, 1.9; 95% CI, 1.0-3.8), but not laser ablation (aRR, 1.1; 95% CI, 0.5-2.4). Moreover, risk of pPROM and total preterm delivery increased significantly with increasing height of tissue removed from the cervix in conization. Women in the highest tertile of cone height (> or =1.7 cm) had a greater than 3-fold increase in risk of pPROM compared with untreated women (aRR, 3.6; 95% CI, 1.8-7.5). LEEP and laser cone treatments were associated with significantly increased risk of pPROM. Careful consideration should be given to treatment of CIN in women of reproductive age, especially when treatment might reasonably be delayed or targeted to high-risk cases.