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

Background: 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. Methods: 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. Results: 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%). Conclusion: 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.

Is cervical cytology testing as a part of co-test unnecessary for HPV 16/18-infected women? A retrospective cohort study of 1647 women.

BACKGROUND: We aimed to present the biopsy results of women with HPV 16/18 infection and investigate whether cytology is necessary as a part of routine cervical cancer screening in women with HPV 16/18. METHODS: This is a retrospective cohort study conducted on 1647 patients between the ages of 30 and 65 years with HPV 16/18 undergoing colposcopy-guided biopsy at a tertiary gynecological cancer center between January-2016 and January-2019. We compared the preinvasive lesion rates and the invasive cervical cancer rates of women with HPV 16/18 between the negative and the abnormal cytology group. RESULTS: Of the 1647 women, 1105 (67.1%) had negative cytology and 542 (32.9%) had abnormal cytology. Among women with initial negative cytology, cervical intraepithelial neoplasia (CIN) 2+ lesion was detected in 205 (18.6%) women. The rate of CIN 2+ lesion in women with abnormal cytology was 28%. There was a significant difference between negative and abnormal cytology group in terms of CIN 2+ lesion rates (P < .001). Among women with initial negative cytology, invasive cervical cancer was detected in 6 (0.5%) women. The rate of invasive cervical cancer in women with abnormal cytology was 8 (1.5%). There was no significant difference between negative and abnormal cytology group in terms of invasive cervical cancer rates (P = .082). CONCLUSIONS: The rate of cervical cancer among HPV 16/18-infected women with negative cytology is similar to women with abnormal cytology. Based on the results of this study, Pap testing could be unnecessary in HPV 16/18-infected women to diagnose invasive cervical cancer who will undergo colposcopy biopsy.

Analgesic efficacy of forced coughing versus local anesthesia during cervical punch biopsy.

BACKGROUND/AIMS: To compare local anesthesia and forced coughing in terms of subjective pain perception during cervical punch biopsy. METHODS: In this randomized controlled trial, 114 patients (mean age: 38.9 ± 9.0 years) scheduled for colposcopically directed cervical punch biopsy were randomly assigned to local anesthesia (n = 39), forced coughing (n = 39) and control (n = 36) groups. Pain perception was measured on a 10-cm visual analog scale (VAS) during the insertion of the speculum, injection of the local anesthetic to the cervix and the taking of the first cervical biopsy, as well as for the overall pain perceived during the entire procedure. RESULTS: Experimental groups were similar in age, gravidity, parity and prior curettage. The pain score obtained during the first cervical biopsy was significantly lower if local anesthesia was applied (p = 0.016). Groups were similar in other pain subscores. The duration of the entire procedure was significantly longer (p < 0.001) in the local anesthesia group, while it was not significantly different in forced coughing patients compared to controls. CONCLUSION: Local anesthesia, but not forced coughing, provides significant pain relief during cervical biopsy. Based on similarity to control data in terms of pain relief and shortening of the operation, forced coughing per se seems related neither to pain relief nor a faster cervical biopsy.