Trend of decreasing length of cervical cone excision during the last 20 years.

OBJECTIVE: The aim of the present investigation was to evaluate the cervical conizations performed in the last 20 years in a single institution, with a particular interest in analyzing the trend of the length of cone excisions. PATIENTS AND METHODS: A retrospective cohort study of women who underwent a CO2-laser cervical conization between January 1996 and December 2015. Cytological abnormalities on referral pap smear, colposcopic findings and pertinent clinical and socio-demographic characteristics of each woman were collected. In particular, the length of cone specimen was evaluated, taking into account all the factors potentially influencing the length of excision. RESULTS: A total of 1270 women who underwent cervical conization from January 1996 to December 2015 were included in the analysis. A mean cone length of 15.1 ± 5.7 mm was reported, and we observed a significant decrease in the length of cone excisions over the whole study period. Age (rpartial = 0.1543, p < 0.0001), see & treat procedure (rpartial = -0.1945, p < 0.0001) and grade II colposcopic findings (rpartial = 0.1540, p < 0.0001) were significantly associated with the length of cone excision on multivariate analysis. CONCLUSIONS: In the last 20 years, a significant decrease in the length of cone excision was observed. In our opinion, this can be due to the acquired awareness by the gynecologists of the potential disadvantages of wide cone excision in term of adverse obstetric outcomes in future pregnancies.

El adenocarcinoma de cérvix como causa infrecuente de sangrado vaginal en la mujer joven / Cervical adenocarcinoma as a rare cause of vaginal bleeding in a young woman

El adenocarcinoma de cérvix es una variedad mucho menos frecuente que el carcinoma epidermoide. En los últimos años parece observarse un incremento en la frecuencia de este tipo de tumor. La variedad villopapilar suele afectar a mujeres jóvenes presentando generalmente un buen pronóstico. Su tratamiento es principalmente quirúrgico, en casos localizados es suficiente la conización pero frecuentemente ha de recurrirse a la histerectomía tratando de conservar anejos para preservar la función endocrina (AU)

Cervical adenocarcinoma is a less frequent variant than squamous carcinoma. The incidence of cervical adenocarcinoma has been increasing over the last several years. Villoglandular papillary adenocarcinoma usually affects young women and generally has a good prognosis. The treatment of this adenocarcinoma is surgical, with conisation being sufficient in localised cases, but a hysterectomy is often necessary to try and preserve the ovaries and maintain endocrine function (AU)

Estudio comparativo de conizaciones realizadas en la provincia de Segovia antes y después del uso del test del virus del papiloma humano (2007-2010) / Comparative study of conizations performed in the province of Segovia before and after the use of the human papilloma virus test (2007-2010)

Objetivo. Este estudio pretende evaluar los cambios epidemiológicos, diagnósticos y terapéuticos en la provincia de Segovia desde la introducción de técnicas de detección de ADN del virus del papiloma humano (VPH) en el cribado de cáncer de cerviz, en mujeres mayores de 30 años en atención primaria en enero de 2009. Material y métodos. Estudio observacional, descriptivo, transversal, retrospectivo, de conizaciones realizadas desde enero de 2007 hasta diciembre de 2010. Se incluye a 86 pacientes: 40 mujeres conizadas en el período 2007-2008 y 46 en el período 2009-2010. Resultados. No se ha incrementado significativamente el número de conizaciones pero sí ha aumentado el número de lesiones de alto grado en citología (p=0,017) y en el estudio histológico posquirúrgico (p=0,047). Observamos un incremento del valor predictivo positivo (VPP) del cribado para lesiones de alto grado, aunque sin significación estadística (p=0,059). Conclusiones. El VPP del cribado de cáncer de cérvix ha aumentado en nuestra provincia con el test de VPH sin aumentar el número de conizaciones (AU)

Objective. To assess epidemiological, diagnostic and therapeutic changes in the province of Segovia since the introduction of techniques for the detection of human papillomavirus (HPV) DNA in cervical cancer screening in women aged more than 30 years in primary care in January 2009. Material and methods. We carried out an observational retrospective study of conization procedures undertaken from January 2007 to December 2010. Eighty-six patients were included: 40 women who underwent conization from 2007-2008 and 46 who underwent the procedure from 2009-2010. Results. The number of conization procedures showed no significant change but the number of high-grade lesions found in cytology (P = .017) and postsurgical histological analysis (P=.047) increased. The positive predictive value (PPV) of screening for high-grade lesions showed a nonsignificant increase (P=.059). Conclusions. The PPV of cervical cancer screening increased in our province with the HPV test, without increasing the number of conization procedures (AU)

Conizacion con asas diatermias en lesiones premalignas de cuello uterino / Loop diathermy conization in premalignant cervical lesions

Objetivo. Comparar la efectividad de la conización uterina en lesiones cervicales intraepiteliales de alto grado (LIEAG) mediante electroescisión quirúrgica con Asa de Trucone o Asa de Leep. Sujetos y métodos. Investigación comparativa, que incluyo 150 mujeres con diagnóstico de LIEAG entre los 20 y 45 años, a las cuales se les practicó conización diatérmicas, separándolas en 2 grupos de acuerdo al tipo de asa utilizada. Resultados. ambas asas fueron efectivas para el manejo de las LIEAG, aunque se encontraron diferencias significativas a favor del asa de Trucone, en cuanto a menor tiempo quirúrgico (X: 3,7±0.52, p<0,01), menor compromiso de los bordes (100% bordes libres; p<0,05) y menor frecuencia de recidivas (94,7%, p>0,01). Conclusiones. aunque ambas asas diatermias resultaron ser efectivas para el tratamiento de las LIEAG, con baja frecuencia de complicaciones y recidivas, el Asa de Trucone mostro presentar mejores ventajas que el Asa de Leep (AU)

Objective. To compare the effectiveness of uterine conization in high-grade cervical squamous intraepithelial lesions (HSIL) by means of surgical electrical excision with Trucone loop or Leep loop. Subjects and methods. We performed a comparative study that included 150 patients, aged between 20 and 45 years, with a diagnosis of HSIL. All patients underwent uterine conization with diathermy loop. The patients were separated into two groups according to the type of loop used. Results. Both loops were effective in the management of HSIL but significant differences were found in favor of the Trucone loop in surgical time (X: 3.7±0.52, p<0.01), lesser margin involvement (100% free margins, p<0.05) and a lower frequency of residual lesions (94.7%, p>0.01). Conclusions. Both diathermy loops were effective in the treatment of HSIL but the frequency of complications and residual lesions was lower with the Trucone loop (AU)

Situación de la conización del cuello uterino en el País Vasco / Conization in the Basque Country (Spain)

Objetivos: El objetivo principal del estudio es determinar cuál es la técnica empleada en el País Vasco para practicar la conización del cuello del útero, así como el lugar más adecuado para practicar una conización (en consulta o en el quirófano), tomando como parámetro la tolerancia al dolor de la paciente, la incidencia de complicaciones inmediatas y tardías, y los resultados anatomo patológicos de los dos procedimientos. Material y métodos: Se seleccionó a 232 pacientes con un diagnóstico citológico y colposcópico de displasia cervical, que debieran estudiarse y/o tratarse mediante un procedimiento excisional del cuello uterino durante el período comprendido entre el 1 de septiembre de 2006 y el 31 de julio de 2007 en 8 hospitales del País Vasco. Resultados: El 94,8% de las conizaciones se hicieron con asa de diatermia en todos los hospitales y, excepcionalmente, con bisturí. La anestesia utilizada fue local en los hospitales terciarios y regional en los hospitales comarcales. La tolerancia al dolor en las conizaciones ambulatorias realizadas con asa de diatermia bajo anestesia local fue excelente. En el Hospital Donostia se puntuó el dolor con una escala analógica visual, logrando puntuaciones bajas concordantes con la alta satisfacción del procedimiento. La afectación de los bordes de la pieza de conización depende del grado de displasia y no de la técnica utilizada. Las complicaciones inmediatas fueron pocas, y fueron incluso menores las tardías (AU)

Objective: The main objective of this study was to evaluate the conization technique used in Basque Country hospitals and to determinate the most appropriate place to perform this procedure (outpatient clinic or operating room) by evaluating pain, early and late complications and histological results. Materials and methods: We selected 232 patients with a cytologic and colposcopic diagnosis of cervical dysplasia requiring surgical cervical conization between September 2006 and July 2007 in eight public hospitals of the Basque Country. Results: A total of 94.8% of conizations were performed with long loop excision of transformation zone (LLETZ) and, exceptionally, with cold knife conization. Local anesthesia was used in tertiary hospitals and regional anesthesia in county hospitals. Pain tolerance in outpatient conization with LLETZ under local anesthesia was excellent. In Hospital Donostia, pain was scored on a visual analogue scale and low scores were achieved, in accordance with the high degree of satisfaction obtained with the procedure. Conization margins depended on the grade of dysplasia rather than on the technique. There were few early complications and even fewer late complications. Conclusion: The LLETZ method performed under local anesthesia in the outpatient clinic is very well tolerated by patients and has few complications. Consequently, this option is a valid alternative to conization under general or regional anesthesia. The LLETZ technique provides multiple advantages for the patient and health service due to its lower cost, without medical disadvantages, and satisfactory tolerance (AU)