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Maluf PJ, Adad SJ, Murta EFC. Outcome after Conization for Cervical Intraepithelial Neoplasia Grade III: Relation with Surgical Margins, Extension to the Crypts and Mitoses. TUMORI JOURNAL 2018; 90:473-7. [PMID: 15656332 DOI: 10.1177/030089160409000506] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Factors linked to residual neoplasia and recurrence following conization of the uterine cervix for treating cervical intraepithelial neoplasia grade III (CIN III), such as the surgical margins, extension of CIN into the crypts and the number of mitoses, have been studied with contradictory results. We evaluated patients submitted to conization for CIN III and analyzed the aforementioned factors, relating them to recurrence and residual neoplasia in hysterectomy specimens. Methods The surgical specimen of cold-knife conization for CIN III performed in 63 patients (average age, 37.3 ± 9.3 years) was fixed in 4% formaldehyde. The ectocervical and endocervical margins were removed and the cone was cut into fragments perpendicular to the surface of the endocervical mucosa (1 mm thick). One histological section (5 μm thick) was cut from each block and stained with hematoxylin-eosin. We studied the total number of fragments from each cone and affected by CIN, endocervical and ectocervical margins, extension to the crypts, number of mitoses and tripolar mitoses in 100 microscope fields using a 100x objective. Results The endocervical margin was involved in 34.9% vs 9.5% (P = 0.001) of ectocervical margins. Recurrence affected 53.8% of cases presenting involved margins versus 12.9% in the cases without involved margins (P = 0.0078). The average interval to recurrence was 3.2 years. CIN was present in 2.5 to 100% (median, 28%) of the cone fragments (median no., 28; range, 7-95). A median of 44.4% and 25% of cone fragments presented CIN with and without recurrence, respectively. Correlation of the number of mitoses with tripolar mitoses and the percentage of fragments involved by CIN with the number of mitoses and tripolar mitoses showed, respectively, P = 0.02, 0.05 and 0.005. A median of 142 mitosis and 4 tripolar mitosis were observed per case with disease recurrence versus 104 and 3 (P = 0.02, 0.6), respectively, when recurrence did not occur. Of 14 patients who underwent hysterectomy after conization (mean, 3.6 ± 3 months afterwards) for endocervical or both margins involved by CIN in the cone specimen, 8 (57.1%) presented CIN III and one (7.1%) microinvasive carcinoma. In 96.8% of the conizations, the CIN extended to the crypts. Conclusions Involved margins and mitoses are associated with a greater recurrence rate for CIN. Residual neoplasia in the hysterectomy specimen after an involved margin with conization is frequent.
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Affiliation(s)
- Paulo José Maluf
- Discipline of Gynecology and Obstetrics, Faculty of Medicine of Triângulo Mineiro, Uberaba-MG, Brazil
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Takač I. Human Papillomavirus Infection in Patients with Residual or Recurrent Cervical Intraepithelial Neoplasia. TUMORI JOURNAL 2018; 94:83-6. [DOI: 10.1177/030089160809400116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The main purpose of this longitudinal study was to evaluate the frequency of HPV infection in patients with residual or recurrent CIN. Methods 797 consecutive patients with CIN, treated with conization, were included. In 38 patients with residual or recurrent CIN in whom reconization was performed, infection with high-risk HPV types was analyzed. Results Reconization was performed in 4.8% of patients. Before reconization, 21 patients (55.3%) were infected with high-risk HPV and 17 patients (44.7%) were HPV negative. Among the HPV-negative patients, two (11.8%) had CIN 1, five (29.4%) CIN 2, nine (52.9%) CIN 3 and one patient (5.9%) had microinvasive cancer of the uterine cervix. The difference in frequency of infection with high-risk HPV was not significant (chi-square 0.372; p>0.05). Conclusions On the basis of the study results it is not possible to recommend the HPV test as the only method of detection of residual or recurrent CIN after conization.
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Affiliation(s)
- Iztok Takač
- University Department of Gynecology and Perinatology Maribor University Hospital, Maribor, Slovenia
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Helena De Lorenzo B, De Carvalho Ramos M, Antoniazi Michelin M, Candido Murta EF. Progress in the use of Immunotherapy to Treat Uterine Cervical Cancer. TUMORI JOURNAL 2018; 95:1-7. [DOI: 10.1177/030089160909500101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cervical intraepithelial neoplasia has a high incidence in many of the world's populations, and it has been hypothesized to be a precursor of uterine cervical cancer. Cervical intraepithelial neoplasia also shares similar pathological traits with human papillomavirus infections. Various surgical treatments have been proposed over the years for the treatment of cervical intraepithelial neoplasia, including conization, hysterectomy and, more recently, a loop electrosurgical excisional procedure. However, a higher recurrence rate of the disease has been observed after these procedures. Therefore, immunotherapy has been proposed as a potential treatment to be used in conjunction with surgery, or independently, as treatment for cervical intraepithelial neoplasia. Currently, immunotherapy includes the application of recombinant viral proteins, vaccines, or antibody- and dendritic cell-based therapies. In this review, we summarize the development and testing of these immunotherapy approaches, particularly in regard to their application for the treatment of cervical intraepithelial neoplasia.
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Affiliation(s)
- Beatriz Helena De Lorenzo
- Research Institute of Oncology (IPON), Discipline of Gynecology and Obstetrics, Universidade Federal do Triangulo Mineiro, Uberaba, Minas Gerais, Brasil
| | - Marisa De Carvalho Ramos
- Research Institute of Oncology (IPON), Discipline of Gynecology and Obstetrics, Universidade Federal do Triangulo Mineiro, Uberaba, Minas Gerais, Brasil
| | - Márcia Antoniazi Michelin
- Research Institute of Oncology (IPON), Discipline of Gynecology and Obstetrics, Universidade Federal do Triangulo Mineiro, Uberaba, Minas Gerais, Brasil
| | - Eddie Fernando Candido Murta
- Research Institute of Oncology (IPON), Discipline of Gynecology and Obstetrics, Universidade Federal do Triangulo Mineiro, Uberaba, Minas Gerais, Brasil
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Cattin J, Rufenacht E, Roesch M, Chehab M, Ramanah R, Riethmuller D. [Evaluation of satisfaction after in-office conization under local anesthesia]. ACTA ACUST UNITED AC 2016; 45:948-954. [PMID: 27114063 DOI: 10.1016/j.jgyn.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Treating cervical intraepithelial neoplasia is essential in cervix carcinoma prevention and conization is the standard treatment. In the current medical and economic context, which advocates the simplification of procedures, loop excision conization is well adapted to an in-office procedure. Therefore, we evaluated the patient satisfaction after an in-office conization. METHOD We conducted an observational study at the Besançon University Medical Centre. Between November 2013 and October 2014, all patients treated by an in-office conization were included. Global satisfaction of patient was retrospectively collected by answering a telephone questionnaire. RESULTS Seventy patients were treated by in-office conization and answered the questionnaire. Global satisfaction was 88.6%. Moreover, 75.7% of patients declared to have felt no pain or moderate pain during the conization. Most of the patients (91.4%) would advise this in-office care to their relatives. The rate of positive margins for dysplasia was 31.4% and postoperative haemorrhage occurred in 7.1%. CONCLUSION In this context of medical care cost reduction, conization seems to be perfectly adapted to in-office surgery. It was also found to be well accepted by patients without raising neither positive margins rate nor postoperative haemorrhage risk.
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Affiliation(s)
- J Cattin
- Pôle mère-femme, centre hospitalier régional universitaire Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - E Rufenacht
- Pôle mère-femme, centre hospitalier régional universitaire Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - M Roesch
- Pôle mère-femme, centre hospitalier régional universitaire Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - M Chehab
- Pôle mère-femme, centre hospitalier régional universitaire Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - R Ramanah
- Pôle mère-femme, centre hospitalier régional universitaire Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - D Riethmuller
- Pôle mère-femme, centre hospitalier régional universitaire Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
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Schneider P, von Orelli S, Roos M, Leo C, Fink D, Wyss P. The value of endocervical curettage after conization for cervical intraepithelial neoplasia. Ann Diagn Pathol 2012; 16:245-9. [DOI: 10.1016/j.anndiagpath.2011.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 08/29/2011] [Accepted: 10/12/2011] [Indexed: 11/29/2022]
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[Importance of human papillomavirus (HPV) screening in the follow-up after CIN2-3 treatment]. ACTA ACUST UNITED AC 2008; 37:329-37. [PMID: 18424016 DOI: 10.1016/j.jgyn.2007.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 05/15/2007] [Accepted: 12/06/2007] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cervical intraepithelial neoplasia (CIN) 2 and CIN3 lesions clearly represent precancerous states even if some of them would heal spontaneously. Management is based on surgical excision of part of the uterine cervix because such lesions can potentially progress into carcinomas. In most cases, this treatment leads to the cure of intraepithelial lesions. However, even after such an efficient treatment, theses patients are still at a higher risk of developing an invasive cervical cancer. That is why guidelines recommend a specific follow-up in order to screen for residual disease (incomplete excision) or for recurrences (after a complete excision). The actual problem in the follow-up strategy lies in the screening tools in use - cervical smears and colposcopy - whose sensitivities are low and hence, not quite sufficient when applied to a high risk population. These intraepithelial lesions are due to high risk human papillomaviruses (HPV) and there cannot be any lesion progression without HPV. Consequently, a viral testing would help in identifying a high risk subpopulation of women after cone loop cervical excision. MATERIAL AND METHODS We studied, retrospectively, the contribution of HPV testing (Hybrid Capture 2((R))) in the follow-up after CIN2-3 treatment in 386 cone loop cervical excisions performed at a single centre during 80 months. RESULTS Between three to six months follow-up after surgery, HPV remained present in 22.5% cases. The sensitivity of HPV testing in the screening for residual lesions or for recurrences was 100%, that of cervical smears cytology was 72%, whereas that of the pathological analysis of margins reached only 67%. The negative predictive value of a negative HPV detection associated with a normal cytology was 100%. DISCUSSION Owing to its clinical relevance, HPV testing optimises postoperative follow-up and leads to the rapid and efficient selection of a subgroup, representing less than one upon three patients who are really at risk of an invasive lesion and to wholly reassure the others. Indeed, a negative HPV testing, associated with a normal cervical cytology, obtained after surgery correspond to a negative predictive value of almost 100% and this allows us to increase the time-interval between two screenings and to rapidly place the patient in a routine follow-up.
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Saah-Briffaut E, Collinet P, Saah R, Boman F, Leroy JL. Prise en charge des lésions malpighiennes intra-épithéliales de type CIN2 et CIN3 par vaporisation au laser. ACTA ACUST UNITED AC 2006; 35:785-9. [PMID: 17151534 DOI: 10.1016/s0368-2315(06)76480-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study was carried out over an 8-year period in order to evaluate the long-term effectiveness of laser CO2 vaporization in the treatment of squamous intraepithelial lesion of type CIN2 and CIN3. MATERIALS AND METHODS A retrospective study of 52 cases of cervical lesions of type CIN2 and CIN3 treated in first intention by laser CO2 vaporization was carried out at the hospital Jeanne-de-Flandre in CHRU of Lille from 1996 to 2003. This treatment was performed on only high-grade exo-cervical lesions, of small size (<2cm2), after a complete colposcopic examination. RESULTS Fifty-two patients were treated by first-intention laser vaporization only. Mean age was 29.4 years and 51.9% were nulliparous. At the first cyto-colposcopic control, there were 17 persistent lesions (32.7%). Among the 35 patients without persistent lesion, 29 achieved cure (absence of recurrence), 4 presented a recurrence and 2 were lost to follow-up. CONCLUSION The current data of the literature concerning the treatment by laser CO2 vaporization authorize application of this method for certain high-grade exocervical lesions after a complete colposcopic examination. This type of treatment remains less aggressive than a surgical treatment. The high rate of residual lesions in particular in the event of CIN3 can be due to an incomplete destruction of the lesion. Patients should thus be advised that monitoring is an integral part of the treatment. Laser vaporization could be limited to CIN1 and CIN2 lesions.
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Affiliation(s)
- E Saah-Briffaut
- Clinique de Gynécologie, Hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille Cedex
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Wick MR, Bourne TD, Patterson JW, Mills SE. Evidence-based principles and practices in pathology: selected problem areas. Semin Diagn Pathol 2005; 22:116-25. [PMID: 16639990 DOI: 10.1053/j.semdp.2006.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Contrary to the intuitive impression of most pathologists, there are still many areas in laboratory medicine where evidence-based medicine (EBM) principles are not applied. These include aspects of both anatomic and clinical pathology. Some non-EBM practices are perpetuated by clinical "consumers" of laboratory services, because of inadequate education, habit, or over-reliance on empirical factors. Other faulty procedures are pathologist-driven, with similar underpinnings. This overview considers several exemplary problem areas representing non-EBM practices in the hospital laboratory. Such examples include ideas and techniques centering on metastatic malignancies, "targeted" oncological therapy, analysis of surgical margins in the excision of neoplasms, general laboratory testing and data utilization, evaluation of selected coagulation defects, administration of blood products, and analysis of hepatic iron-overload syndromes. The concepts illustrating departures from EBM are discussed for each of those topics.
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Affiliation(s)
- Mark R Wick
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia 22908-0214, USA.
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Bretelle F, Agostini A, Rojat-Habib MC, Cravello L, Roger V, Blanc B. The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.02268.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Cervical cancer is one of the most devastating conditions that can complicate a pregnancy. Stage for stage, treatment for squamous cell cervical cancer is the same as that given in the non-pregnant patient. Radical surgery is the treatment of choice for the early stages of the disease. Although a planned delay in therapy may be considered for up to 20 weeks, for stages IA and IB1, it should be implemented cautiously and with the patient's full awareness of the risks. If delay is considered for higher stages, the patient must be aware of the paucity of data to support this plan. Chemoradiation is the standard treatment for advanced cancer of the cervix. When acceptable fetal maturity has been reached, a classical Caesarean section is usually performed prior to definitive treatment.
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Affiliation(s)
- Sarah D McDonald
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON
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