Conization Using Electrosurgical Conization and Cold Coagulation for International Federation of Gynecology and Obstetrics Stage IA(1) Squamous Cell Carcinomas of the Uterine Cervix
ABSTRACT This study was performed to evaluate the efficacy and feasibility of electrosurgical conization and cold coagulation as definitive treatments for patients with International Federation of Gynecology and Obstetrics stage IA1 squamous cell carcinoma of the cervix and a resection margin free from (micro)invasive carcinoma after conization.
Patients with stage IA1 cervical squamous cell carcinoma without lymphovascular space invasion who had been treated by electrosurgical conization and cold coagulation and who wanted to preserve fertility (or only undertake conservative treatment) were followed up without further surgical intervention. Patients with invasive or microinvasive carcinoma at resection margins or positive endocervical resection margins were excluded from the study. Cervicovaginal smears and colposcopic examination were performed at regular intervals. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia 2 or higher-grade lesions.
A total of 85 patients enrolled were deemed eligible to be involved in the study. The median follow-up period was 81.0 months (range, 13-127 months). Nineteen of the 85 patients had exocervical resection margins. There was one case of recurrence, which was node-positive invasive cancer recurrence (1.2%, 1/85), in patients with negative resection margins.
These results suggest that electrosurgical conization with cold coagulation is a feasible treatment and could be used as a definitive therapy for patients with stage IA1 cervical squamous cell carcinoma without lymphovascular space invasion. In addition, patients having cervical intraepithelial neoplasias 2 and 3 at exocervical resection margins could be followed up carefully without further treatment after conization and cold coagulation.
[Show abstract] [Hide abstract]
ABSTRACT: To assess the management and outcome for women with microinvasive cervical cancer with stromal invasion 1 mm or less, examining the impact of re-excision. A retrospective cohort study with interval analysis performed between December 2000 and December 2010. Sheffield Gynaecological Cancer Centre and Jessop Wing Colposcopy Unit, Sheffield, UK. Women diagnosed with microinvasive cervical cancer with stromal invasion 1 mm or less during the allocated study period. Methods used is a retrospective cohort study. Risk of recurrence and mortality from disease; incidence of residual disease in repeat excision specimens. A total of 140 women were identified as having microinvasive cervical cancer with stromal invasion 1 mm or less. Sixty-three (45%) had a completely excised lesion; 77 (55%) had an incompletely excised lesion at first treatment. Fifty-five women underwent repeat excision. No residual disease was found in the majority (n=40; 73%). No women suffered disease recurrence or died from disease during the allocated study period. Outcome for women with microinvasive cervical cancer with stromal invasion 1 mm or less is excellent. Repeat excision is associated with very low rates of residual disease. A more conservative approach to follow-up incorporating HPV testing should be explored.International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists 07/2012; 31(5):470-4. DOI:10.1097/PGP.0b013e31824a1d8d · 1.63 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background Cold coagulation is an ablative method for treatment of cervical intraepithelial neoplasia (CIN). Despite reports of efficacy against all grades of CIN (CIN1-3), cold coagulation has been infrequently used since the 1980s, and was absent from the recent Cochrane review on CIN treatment. Objectives To provide a systematic review of cold coagulation efficacy and acceptability for CIN treatment through meta-analysis of clinical reports and a randomised control trial. Search strategyA literature search in PubMed, Web of Science, EMBASE, and regional databases yielded 388 papers. Title, abstract and/or reference list review identified 22 papers describing cold coagulation treatment of CIN, with 13 providing adequate data for inclusion in the meta-analysis. Selection criteriaPublications or conference abstracts describing original data (number of women treated, followed up and cured, provider type, cure definition) were retained. No language or publication date limitations were imposed. Data collection and analysisData extracted from 13 studies were pooled, and statistical analyses of proportion cured were conducted with data stratified by lesion grade and study region. Main resultsAmong 4569 CIN patients treated with cold coagulation, summary proportion cured of 96% [95% confidence interval (CI) 92–99%] and 95% (92–98%) were obtained for CIN1 and CIN2-3 disease, respectively. Side-effects and adverse effects were infrequent, and fertility was not impaired. Conclusions Cold coagulation CIN cure rates were comparable to those of other excisional and ablative methods. Cold coagulation is indicated for all grades of CIN, is safe, quick and acceptable, and may be of particular relevance for use in resource-limited settings.BJOG An International Journal of Obstetrics & Gynaecology 03/2014; 121(8). DOI:10.1111/1471-0528.12655 · 3.86 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: To determine the risk of extracervical disease in patients with stage IA1 squamous cell carcinoma of the cervix. A retrospective analysis was performed of 169 patients who had stage IA1 cervical cancer after conization at Seoul National University Hospital between 1997 and 2007. During the study period, 18 patients had conization as a definite treatment and 151 underwent subsequent surgery ranging from simple hysterectomy to radical hysterectomy with lymphadenectomy. Of the 151 patients who underwent subsequent surgery following conization, 35 (23.3%) patients underwent a simple hysterectomy, 20 (13.1%) a simple hysterectomy with pelvic lymphadenectomy and 96 (63.6%) radical surgery with lymphadenectomy. No parametrial involvement or lymph node metastasis was noted in any of the patients who underwent parametrial resection and/or lymphadenectomy. Of the 62 patients who had negative resection margins in conization specimens, only one presented with residual tumor in subsequent surgery. One recurrence of the disease was identified in the total sample (169 patients) with a median follow-up time of 99 months. The risk of extracervical disease following conization is negligible, even for patients with positive resection margins in conization specimens. A more conservative and less aggressive approach may be possible for this patient subset.Journal of Obstetrics and Gynaecology Research 04/2014; DOI:10.1111/jog.12330 · 0.93 Impact Factor