Efectividad del cono LEEP en pacientes con lesiones intraepiteliales de alto grado en la Unidad de colposcopia del Servicio de Ginecología del Hospital de la Mujer / Effectiveness of the LEEP cone in patients with high-grade intraepithelial injuries in the colposcopy Unit of the Gynecology Service of La Mujer Hospital

OBJETIVO. Determinar la efectividad del CONO LEEP en pacientes con lesión intraepitelial de Alto Grado (LIE AG). MATERIAL Y MÉTODO. Estudio de tipo descriptivo, retrospectivo y transversal que incluyo a 68 pacientes quienes fueron sometidas a CONO LEEP por lesiones intraepiteliales de alto grado en el año 2014 en la unidad de colposcopia del Hospital de la Mujer. Se analizó la efectividad a través de la persistencia y/o recidiva de los controles posteriores en el año 2015. RESULTADOS. 33 pacientes realizaron control PAP posterior al CONO LEEP siendo el resultado citológico negativo para lesión intraepitelial más frecuente llegando a un porcentaje de 91% (30 pacientes). Se identificó que el 9% (3 pacientes) presento persistencia al tratamiento con CONO LEEP. CONCLUSIONES. El estudio determino la efectividad del procedimiento en las pacientes que acudieron a control citológico, se estimó en 91 %, lo cual demuestra que la conización es un método de ALTA EFECTIVIDAD con un 9% de persistencia encontrándose en los rangos esperados de persistencia de la NIC que es entre el 5 y el 17% de acuerdo a protocolos de Brasil, México y España.

OBJETIVE. To determine the effectiveness of the LEEP CONE in patients with High Grade Intraepithelial Lesion (HLL). MATERIAL AND METHOD. A descriptive, retrospective and crosssectional study that included 68 patients who underwent LEEP CONE for high-grade intraepithelial lesions in 2014 in the colposcopy unit of La Mujer Hospital. The effectiveness was analyzed through the persistence and / or recurrence of subsequent controls in 2015. RESULTS. 33 patients underwent PAP control after the LEEP CONE, the cytological result being negative for the most frequent intraepithelial lesion, reaching a percentage of 91% (30 patients). It was identified that 9% (3 patients) presented persistence to treatment with LEEP CONE. CONCLUSIONS. The study determined the effectiveness of the procedure in patients who attended cytological control, it was estimated at 91%, which shows that conization is a HIGH EFFECTIVENESS method with a 9% persistence, being in the expected ranges of persistence of the NIC which is between 5 and 17% according to the protocols of Brazil, Mexico and Spain.

Neoplasia intraepitelial escamosa cervical de alto grau: abordagem ambulatorial / High-grade cervical intraepithelial neoplasia: outpatient approach

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

A randomized clinical trial of a new anti-cervical stenosis device after conization by loop electrosurgical excision.

BACKGROUND: The complications inherent to conization include vaginal bleeding, cervical stenosis, amenorrhea, dysmenorrhea, and deep dyspareunia. Cervical stenosis is the most important complication due to the clinical repercussions. Studies show rates of cervical stenosis ranging from 1.3 to 19% after the Loop Electrosurgical Excision Procedure (LEEP). OBJECTIVE: Our primary outcome was to compare the role of a new endocervical device to prevent cervical stenosis after LEEP in patients with high-grade squamous intraepithelial lesions (HSILs). METHODS: A randomized clinical trial was performed including phases II and III for evaluation of a new device for cervical stenosis prevention. In Phase II, we included 25 patients who underwent LEEP and placement of the device to assess its toxicity and efficacy. In phase III, we compared two groups (with and without the use of an anti-stenosis device) to evaluate its efficacy and safety. RESULTS: From August 2015 to June 2018, 265 participants were randomized (Phase II: 25, Phase III: 120 with DUDA and 120 without DUDA). The toxicity during phase II was observed in only one patient (4%) with pain grade > 7. There were 7 cases of toxicity during Phase III, 2 in the DUDA group (1.8%), and 5 in the No DUDA group (4.5%). The complications rate was numerically higher in the No DUDA group (2.5x higher) than the DUDA group, but this difference did not reach statistical significance (p = 0.52). The rate of cervical stenosis in DUDA group was (4-7,3%), and in No DUDA group was (4.3-5.8%) (p = 0.5). We did not find a significant difference when comparing the evolution at 3, 6, and 12 months in terms of cervical patency and visualization of the squamocolumnar junction (SCJ) during colposcopy. The DUDA group exhibited 15% to 19% nonvisualization of the SCJ, whereas that rate ranged from 10 to 12% in the No DUDA group. CONCLUSIONS: The rate of cervical stenosis was not different comparing the use of a new device, specifically produced to prevent cervical stenosis, compared to no use after LEEP procedure. This clinical trial opens up space for a discussion of the utility of using cervical stenosis devices after LEEP. Perhaps in another type of conization it can be evaluated to avoid cervical stenosis.

Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study.

OBJECTIVE: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). METHODS: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. RESULTS: Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). CONCLUSIONS: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.

Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study.

OBJECTIVE: Large loop excision of the transformation zone (LLETZ) conization has been associated with adverse obstetrical outcomes. In an approach to reduce the number of performed LLETZ procedures, we conducted this study to evaluate whether "diagnostic" LLETZ should still be performed, by analyzing their yield in terms of detection (and treatment) of real high-grade squamous intraepithelial lesion (HSIL). METHODS: During a two-year study period, all patients who underwent a LLETZ procedure in our institution were retrospectively included. Study participants were divided into two groups according to LLETZ indication: a biopsy-proven HSIL group, and a non-biopsy-proven HSIL group. The results of the final histological examination were recorded, as well as excision margin status and specimen dimensions. RESULTS: During the two-year study period, 396 LLETZs were performed, 283 (71%) of which were indicated by biopsy-proven HSIL. In the non-biopsy-proven group, final histology showed 50 cases of HSIL (44%) and 4 cases of carcinoma (3.6%), versus respectively, in the biopsy-proven group, 221 (78%) HSIL and 28 (9.9%) carcinoma (p<0.001). Regarding margin status and specimen dimensions, no intergroup difference was observed between the two groups. CONCLUSION: So called "diagnostic" LLETZ allowed the detection of severe cervical lesions in almost half of cases, without increasing specimen dimensions in comparison with classical conization indications. Moreover, they also allowed an efficient treatment as showed by similar margins status. Our results therefore strengthen the idea that "diagnostic" LLETZ, when specific indications are respected, should not be overlooked as a major part of our therapeutic arsenal.

The effects of different instruments and suture methods of conization for cervical lesions.

This study is to compare the surgical outcomes of patients undergoing cold knife conization (CKC) versus electrosurgical conization (ESC). Among 10,086 patients in a single center admitted between January 2000 and January 2019, CKS or ESC was used for grade 3 cervical intraepithelial neoplasia (CIN3) or more severe lesions. Modified Sturmdorf or Figure-of-eight sutures were applied after conization. A regression model was used to determine the risk factors for margin involvement and short-term post-operative complications. In total, 7275 (72.1%) and 2811 (27.9%) patients underwent CKC and ESC, respectively. Women who underwent ESC were older and had a higher risk of margin involvement and endocervical glandular involvement than those who underwent CKC in univariate analysis. However, in the multivariate analysis, age (odds ratio [OR] 1.032, 95% confidence interval [95% CI] 1.025-1.038) and glandular involvement (OR 2.196, 95% CI 1.915-2.517) were the independent risk factors associated with margin involvement, but the incision methods used caused no significant difference. Modified Sturmdorf sutures and Figure-of-eight sutures were applied in 3520 (34.9%) and 6566 (65.1%) patients, respectively. The modified Sturmdorf sutures was the only risk factor associated with wound hemorrhage (OR 1.852, 95% CI 1.111-3.085) after adjusted with other epidemiological and surgical factors. Various incision or suture methods had similar risk of cervical stenosis. Therefore, ESC is an acceptable alternative to CKC for the diagnosis and treatment of cervical lesions regarding the pathologic accuracy and integrity, and short-term safety. Modified Sturmdorf sutures increased the risk of wound hemorrhage compared with Figure-of-eight sutures.

Comparison of Electrosurgical Devices for Cervical Conization: Novel Monopolar Scalpel (VIO) Versus Ultrasonic Scalpel.

OBJECTIVE: The aim of this study was to compare the outcomes associated with the use of a novel monopolar scalpel with those associated with the use of an ultrasonic scalpel for cervical conization of cervical intraepithelial neoplasia. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study in patients treated in our institute between April 2010 and March 2017. We used either the VIO monopolar scalpel (VIO) or Harmonic ultrasonic scalpel (HS) for cervical conization. We analyzed operative outcomes, postoperative complications, and pathological findings associated with the use of the 2 devices. RESULTS: In 500 patients treated with cervical conization, VIO and HS were used in 249 and 251 patients, respectively. No significant difference in patient background was found between the groups. The mean operative time was shorter with VIO than with HS (18.2 min vs. 27.4 min). The mean estimated blood loss was greater with VIO (7.2 g vs. 3.1 g), but the postoperative bleeding rate was higher with HS (5% vs. 20%). Regarding other complications, cervical stenosis was only noted with VIO (4 cases, 1.6%). The positive margin (11% vs. 16%) and positive endocervical curettage rates (7% vs 10%) were not significantly different between the groups. No significant differences were also found in the pathological results and need for additional treatment (the rate of the additional treatment: 20% vs. 23%). CONCLUSIONS: Considering short operating time and less postoperative bleeding, VIO was preferred to HS. However, the excessive coagulation in VIO is considered to lead to cervical stenosis.

Factors That Influence Surgical Margin State in Patients Undergoing Cold Knife Conization - A Single Center Experience.

AIM: To evaluate the factors that influence the surgical margin state in patients undergoing cold knife conization at the University Clinic of Gynecology and Obstetrics in Skopje, Republic of Macedonia Materials and methods: We have retrospectively analyzed the medical records of all patients that underwent a cold knife conization at our Clinic in 2015. We cross-referenced the surgical margin state with the histopathological diagnosis (LSIL, HSIL or micro-invasive/invasive cancer), menopausal status of the patients, number of pregnancies, surgeon experience, operating time and cone depth. The data was analyzed with the Chi square test, Fisher's exact test for categorical data and Student's T test for continuous data and univariate and multivariate logistical regressions were performed. RESULTS: A total of 246 medical records have neen analyzed, out of which 29 (11.79%) patients had LSIL, 194 (78.86%) had HSIL and 23 (9.34%) patients suffered micro-invasive/invasive cervical cancer. The surgical margins were positive in 78 (31.7%) of the patients. The average age of the patients was 41.13 and 35 (14.23%) of the patients were menopausal. The multivariate logistic regression identified preoperative forceps biopsy of micro-invasive SCC, HSIL or higher cone specimen histology and shorter cone depth as independent predictors of surgical margin involvement in patients undergoing cold knife conization. CONCLUSION: In the current study, we have found no association between the inherent characteristics of the patient and the surgeon and the surgical margin state after a CKC. The most important predictors for positive margins were the severity of the lesion and the cone depth.

Pregnancy outcome after the treatment of loop electrosurgical excision procedure or cold-knife conization for cervical intraepithelial neoplasia.

OBJECTIVE: The aim of this study was to investigate the influence on fertility and pregnancy outcome in cervical intraepithelial neoplasia (CIN) patients after a loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC). METHODS: 269 patients with CIN-II-III who wanted to conceive were prospectively enrolled in this randomized clinical trial to receive either the LEEP or CKC procedure. Fertility, neonatal and maternal outcomes were observed and compared. RESULTS: 244 evaluable patients were divided into two groups. There were 124 in the LEEP group and 120 in the CKC group. The preterm premature rupture of membranes (16 vs. 8%; p = 0.03), preterm delivery rate (11 vs. 5%; p = 0.04) and low birth weight infants rate (<2,500 g) (10 vs. 6%; p = 0.04) were higher in the CKC group than in the LEEP group, but there was no difference in mean birth weight, cesarean delivery, labor induction, or neonatal intensive care unit admission. There was no case of neonatal mortality. CONCLUSIONS: In a prospective evaluation the findings of this study demonstrate that LEEP is safer for future pregnancies when compared to CKC. LEEP should be an appropriate choice for patients with CIN who want to become pregnant later in life.

Treatment options for high-grade squamous intraepithelial lesions.

The introduction of testing for high-risk HPV types and P16 immunostaining of CIN2 histologic specimens allows for determination of the risk of progression versus regression for a woman with a particular cytologic or histologic specimen. Observation with serial cytological or colposcopic examinations is now appropriate for women with low-grade histologic lesions as well as pregnant and young women with certain high-grade histologic lesions. Current recommendations for management of high-grade lesions, the efficacy of treatment options (cryotherapy and LEEP), and the immediate (bleeding, infection) and longer term complications (cervical incompetence, preterm delivery) of cervical dysplasia treatment are presented.

[Appraisal of the optical diagnostic technique for cervical intra-epithelial neoplasia by polarimetric imaging "Polcolpo". Comparison with colposcopic and histological diagnoses by biopsy]. / Étude prospective comparant les performances de la colposcopie classique à la colposcopie guidée par polarimétrie sur la détection des néoplasies intra-épithéliales du col utérin.

OBJECTIVES: The main objective of this study was to compare the performances of polarimetric imaging and standard colposcopy for the detection of CIN. MATERIALS AND METHODS: We performed a monocentric prospective clinical study. The standard colposcopic diagnosis obtained during a first consultation was compared to the diagnosis provided by polarimetric imaging in a second consultation. In addition to the biopsies guided by classical or polarimetric colposcopy, a systematic biopsy taken at a predefined location allowed to calculate the specificities and sensitivities of both techniques. RESULTS: One hundred and forty-one patients were included, all of them with anomalous Pap smears. Sixty-seven cone biopsies were taken, 69 % of which were eventually diagnosed with CIN2+ lesions. The sensitivities and specificities were found to be equal for standard and polarimetric colposcopies. CONCLUSION: We could not demonstrate any improvement of the diagnostic performances with polarimetric colposcopy alone. However, for both healthy and pathological cervices, we observed interesting polarimetric responses involving other characteristics than those we initially assumed, and which will be taken into account in a future study.

Conization using the Shimodaira-Taniguchi procedure for adenocarcinoma in situ of the uterine cervix.

OBJECTIVE: The Shimodaira-Taniguchi conization procedure addresses the disadvantages of the loop electrosurgical excision procedure (LEEP) by using a high frequency current and a triangular probe with a linear excision electrode to extract the tissue as a single informative specimen, without incurring accompanying thermal trauma. The aim of the present study was to analyze the surgical efficacy of the Shimodaira-Taniguchi conization procedure for adenocarcinoma in situ (AIS) of the uterine cervix. STUDY DESIGN: At the Osaka University Hospital, conization using the Shimodaira-Taniguchi procedure has long been routinely performed for AIS. Medical records of patients during the period from 2005 to 2011, whose post-conization diagnosis was AIS, were retrospectively analyzed. A literature review was conducted of the PubMed database to clarify the surgical outcome efficacy of the Shimodaira-Taniguchi procedure compared to other procedures. RESULTS: During the study period, a post-conization diagnosis of AIS was made in 10 patients. A positive resection margin was detected in 4 of the 10 cases (40%), and residual disease was observed in 3 cases (30%). A review of the relevant literature indicates that the rate of positive margin and residual disease by the Shimodaira-Taniguchi procedure, including our cases, was not significantly different from the cold knife, LEEP or laser procedures (p=0.32, 0.99, and 0.40, respectively, for positive margin, and p=0.76, 0.94, and 0.063, respectively, for residual disease). CONCLUSION: AIS was demonstrated to be efficaciously treated, with a low risk of residual disease, by the Shimodaira-Taniguchi conization procedure. Further study is still needed to establish a standard of conservative treatment for AIS.

[Our and foreign experience in surgical treatment of CIN III-cold knife conisation versus LLETZ].

AIM: Our aim was to assess the treatment results of patients with CIN III- surgically treated with cold knife cone biopsy compared with the results of treatment with LLETZ and laser conisation. MATERIALS AND METHODS: 600 patients were assessed and researched for 10 years period. Some of them were from the Specialized Hospital for Active Treatment in Oncology-Sofia, some from RHW and some from the Medical University of Varna-Cathedra of Obstetrics and Gynaecology. 350 patients were operated by the classical method- cold knife conisation, 200 by LLETZ and 50 by laser cone biopsy. RESULTS: We didn't find any difference in patients age, their cytological results and the results of their treatment. The LLETZ showed good results according to resected margins. The same good results were observed with laser conisation. Invasive disease and recurrence were observed in 150 patients--50 of them having adenocarcinoma in situ. CONCLUSIONS: Our research showed that there is no difference in the results of both groups- treated by the classical way--cold knife conisation or by LLETZ and laser conisation.

[Clinical efficacy of a new method for LEEP conization with pistol-shaped electroknife].

The aim of this study is to establish clinical efficacy of a new method for LEEP conization of uterine cervix. The study is open, retrospective, performed at Department of General and Oncogynecology - Military Medical Academy (Sofia, Bulgaria) for the duration from 2007 till Mar 2010. The study includes 37 women at age from 19-50 years with proved high grade CIN (included Ca coil uteri in situ) by abrasion or biopsy. Medical history was collected from all patients enrolled in the study as well as gynecological examination and colposcopy was performed to them. A LEEP with short intra venues anesthesia was performed to the patients. An innovation system for LEEP conization and generator for monopolar currency ERBE VIO 300D was used. The follow up visit was performed one month after the treatment procedure and included gynecological examination and colposcopy (positive/negative atypical colposcopy results). The clinical efficacy of the method was evaluated on the base of histological results. The patients whose histological results show negative endocervical margins were accepted for cured. From 37 patients in total with different stage of dysplasia and carcinoma in situ hospitalized at Clinic of surgical gynecology for surgical treatment, in 33 (89%) there are negative endocervical margins. These patients formed the cured group. In four patients (10.8%) were discovered histological evidences for positive endocervical margins. The LEEP was not the final operative procedure for them. They were included in the uncured group. The final results achieved from the study about the efficacy of the used method LEEP has statistical significance (d.f .= 1, X2 = 2.82, p < 0.05). The data shows that the LEEP eliminate completely the affected by malignant process areas of cervix uteri. The LEEP can be used as a common surgical method in the treatment of the women with high stage of pre-carcinoma and carcinoma in situ coli uteri.

First experience of a modified device for excision of the endocervix in a reverse cone during laparoscopic supracervical hysterectomy.

The objective of this study was to evaluate the performance and safety of a modified unipolar electrode developed for excision of the endocervix in a reverse cone pattern during laparoscopic supracervical hysterectomy (LSH) to reduce the occurrence of persistent vaginal bleeding after the procedure. The study is a prospective pilot trial performed at a Norwegian university teaching hospital. Excision of the endocervix was performed with the unipolar electrode immediately after the amputation of the cervix during LSH in 23 consecutive women referred to the department for hysterectomy on the basis of a benign condition. The mean duration of the inverse conization was 61.9 seconds (SD 24.7). The excision of the endocervix in a reverse cone pattern was reported to be without technical problems in 22 procedures (96%). The results of this pilot study indicate that the modified device is safe, technically easy to use, and prolongs the duration of the LSH procedure insignificantly. Long-term effects of the device will be evaluated in a prospective randomized trial.

Miniconization procedure with C-LETZ conization electrode for treatment of cervical intraepithelial neoplasia: a Swedish study.

BACKGROUND: Since 1989 large loop excision of the transformation zone (LLETZ) has become the treatment of choice for cervical intraepithelial neoplasia in many colposcopy clinics. This method has limitations however, in that the resection margins of the cone produced by LLETZ cannot give conclusive histological reassurance, because of thermal injury in 5 30% of the specimens. Furthermore, LLETZ are often taken in several sections, which makes the histopathological examination unnecessarily difficult. As a new and single treatment without these limitations, conization with the contoured loop excision of the transformation zone (C-LETZ) electrode was investigated in the present study. Material and methods. One hundred and seventy-four patients with CIN were treated with the C-LETZ electrode during 12 months at the Gynaecological Department, Karolinska University Hospital, Huddinge. The inclusion criteria were a histological diagnosis of CIN II-III, or persistent CIN I. RESULTS: Eighty-six per cent of the patients had a complete excision according to histological findings, and 12% had an incomplete excision. The frequency of incomplete excisions increased with the severity of the CIN but were found in all groups of patients: 1 (3%) in CIN I, 5 (12%) in CIN II, and 12 (17%) in CIN III. The resection margins and histological diagnoses were certain in 98% of the cases. A cure rate of 90% was observed. Conclusions. Miniconization with the C-LETZ electrode makes it possible to individualize the size of the minicones and produce the minicones as one-piece specimens for histopathological assessment. Our findings confirm that this method is a reproducible, safe, and economical way to treat CIN with a low rate of morbidity in a hospital outpatient setting.

Conservative treatment of cervical intraepithelial neoplasia using a cold-knife section technique.

OBJECTIVE: The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of childbearing potential and extent of dysplasia. DESIGN: Prospective study. SETTING: Gynecological Oncology Department in French Public Hospital. POPULATION: A total of 460 women treated for CIN between 1985 and 1999 were included. METHODS: A conservative cold-knife cervical section followed by blanket suture reconstruction was used in all cases. MAIN OUTCOME MEASURES: Immediate operative results, recurrence and reproductive function were assessed. RESULTS: The mean length of the cervical specimen was 11.4 mm (range, 4-22 mm). Mean specimen thickness was strongly correlated with age: 10.6 +/- 4.1 mm in women <40 years versus 12.1 in women >40 years; p < 0.001. Complete excision was achieved in 395 cases (85.8%). Post-operative bleeding was observed in 5 cases (1.1%). The mean duration of follow-up was 62 months (range, 12.3-156.5 months). Recurrences developed in 26 patients (6.6%) including CIN 1 in 9 cases, CIN 2 in 9 and CIN 3 in 8. No patient developed carcinoma. The actuarial risk of recurrence was 2.4% (+/- S.D., 0.9) at 24 months and 7.8% (+/-S.D., 1.9) at 60 months. A total of 52 pregnancies were observed in 39 patients. No case of de novo infertility was reported post-operatively. Amenorrhea was noted in 1 patient (0.1%) and dysmenorrhea in 1 patient (0.1%). CONCLUSIONS: This conservative cold-knife section technique is effective for treatment of CIN with low morbidity and little adverse effect on childbearing potential. Exposure of the squamocolumnar junction (SCJ) greatly facilitates follow-up.

[A useful technical device to improve the sampling of uterine cervical conization]. / Un utile accorgimento per l'ottimizzazione delle tecniche di riduzione delle conizzazioni cervicali uterine.

Standardized procedures regarding the sampling of cervical conization are extensively described in the Literature. The cervical cone dimension depends on the surgical technical approach and on the extension of the dysplasic/neoplastic lesion. Current sampling procedures frequently turn out to be of problematic correct realization, with special regard to small size cervical cones and to fixed material with subsequent artefactual tissue coarctation. Here we describe a simple device, which makes the cone sampling procedure easier and more accurate, allowing better oriented and better recomposed samples. Perpendicular sections to the cervical lumen allow in fact an accurate evaluation of the lesion's depth and of the status of the resection surgical borders. After conization, preventive agreements with the surgeon provide that, before fixation, a 2-3 mm in diameter smooth plastic probe is inserted into the cervical channel, from the external cervical os to the conization apex (a fragment of the handle of an endocervical cytological brush can be used). The insertion of such a "specillum" must be performed with warning gently since superficial cervical epithelium, especially if dysplasic (overall in case of severe dysplasia), is particularly subjected to mechanical abrasions. The preventive insertion of the endocervical probe makes the cone sampling more manageable, in fact the cervical channel is slightly dilated and the subsequent fixation hardens the cone tissues. After the "specillum" extraction, the cervical lumen appears clearly visible; in such a situation, the endocervical cone apex will be exactly sampled, and the subsequent seriated clockwise sampling of the residual cone will be more smoothly performed, with following preparation of adequate histological sections 4. In our experience such a simple and easy-to-apply device, proves to be useful in making the uterine cone sampling more accurate and comfortable.

A stiff bristled, spiral-shaped ectocervical brush: a device for transepithelial tissue biopsy.

OBJECTIVE: To compare a new spiral-shaped tissue-sampling brush with a standard cervical punch biopsy. METHODS: Before large loop excision of the transformation zone, women with cervical intraepithelial neoplasia underwent a transepithelial brush biopsy of a portion of a colposcopically identified lesion, followed by a punch biopsy of the remaining portion. Brush biopsy samples were processed using liquid-based cytology and cell block techniques. Diagnoses were made using a consensus of three pathologists. Brush biopsy samples without basal cells were considered inadequate. The histological diagnosis was compared with the brush biopsy and punch biopsy samples. Patient-reported pain and physician-reported bleeding for punch and brush biopsies were compared. RESULTS: Fifty-two women were enrolled in the study; 47 successfully completed the study protocol. Eight brush biopsy specimens were inadequate. Thirty-nine women showed abnormal pathology (human papillomavirus/cervical intraepithelial neoplasia I or worse) on large loop excision of the transformation zone, and 32 women had high-grade (or worse) lesions. The punch biopsy correlated with high-grade disease in 53.1% of these women. The brush biopsy result correlated with high-grade disease in 79.3% of these women using a cell block technique and 76.7% using liquid cytology. There was significantly less pain (P <.001) and significantly less bleeding (P <.001) with the brush biopsy. CONCLUSION: When an adequate sample is collected, spiral brush biopsy is as good as a standard punch biopsy for detecting cervical pathology, with substantially less pain and bleeding. User training and guidelines for sampling are needed to assure that an adequate sample is collected.