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Tuil A, Bergeron C, Lucet JV, Dabi Y, Favier A, Da Maia E, Uzan C, Mergui JL, Canlorbe G. Vulvar biopsy: Punch biopsy or cervical forceps biopsy? J Gynecol Obstet Hum Reprod 2023; 52:102667. [PMID: 37709202 DOI: 10.1016/j.jogoh.2023.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES The primary objective of our study is to investigate the rate of non-contributory biopsies between punch biopsy(PB) and cervical forceps biopsy(CFB) for a vulvar lesion seen in consultation. The secondary objective of our study is to evaluate the rate of underestimation of a more severe lesion for patients who have undergone vulvar excision. MATERIAL AND METHOD This is a retrospective, descriptive, and comparative study conducted at three centers. The study population consisted of patients who underwent vulvar biopsy between 2017 and 2022 in a gynecological surgery consultation at two French hospitals, as well as a city office. The biopsy techniques used were punch or cervical forceps biopsy. Quantitative variables were analyzed using the Mann-Whitney test, while Pearson's or Fisher's Xi2 tests were used for qualitative variables. The significance level was set at 5%. RESULTS We conducted a retrospective study of 179 vulvar biopsies, of which 100 were punch biopsies and 79 were cervical forceps biopsies, from a total of 107 patients. There was no significant difference in the rate of non-contributory biopsies between the PB and CB groups (p = 1). When analyzing the secondary endpoint of our study, which included 68 patients who underwent vulvectomy after vulvar biopsy, we found that 66 patients (97%) had a good correlation between the pathology of the vulvar biopsy and that of the vulvectomy specimen. CONCLUSION Vulvar biopsy techniques using punch or cervical forceps appear to have similar diagnostic performance and are associated with comparable and low rates of underestimation of invasive lesions.
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Affiliation(s)
- Anthony Tuil
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France.
| | | | - Justine Varinot Lucet
- Service d'anatomie et de Cytologie Pathologiques, Hôspital Tenon, AP-HP, Paris, France
| | - Yohann Dabi
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - Amélia Favier
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - Elisabeth Da Maia
- Service d'anatomie et de cytologie pathologiques, Pitié-Salpêtrière, AP-HP, Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris 75012, France; University Institute of Cancer, Sorbonne University, Paris 75013, France
| | - Jean-Luc Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 26 rue Lazare Carnot, Paris 75013, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris 75012, France; University Institute of Cancer, Sorbonne University, Paris 75013, France
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Freisleben M, Petzel A, Jülicher A, Jonas A, Betzler J, Choly N, Pashayeva E, Porthun J, Welcker T, Schneider V, Kaufmann AM, Schneider A. Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic? Geburtshilfe Frauenheilkd 2023; 83:1263-1273. [PMID: 37808260 PMCID: PMC10556877 DOI: 10.1055/a-2150-0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
Aim In Germany, treatment of HSIL or AIS of the uterine cervix by loop excision is performed almost exclusively under general anaesthesia (GA). International studies and guidelines show high acceptance of local anaesthesia (LA) due to hermeneutic, medical, and economic factors. We performed an observational comparative study aiming to prove advantages of local anaesthesia within the German health system. Patients and Methods In a prospective observational study, patients diagnosed with HSIL or AIS of the uterine cervix were treated at the Institute for Cytology and Dysplasia, Berlin, by loop excision in 2021. We started with a feasibility study : 303 patients diagnosed with HSIL/AIS of the uterine cervix and her colposcopist answered an electronic questionnaire with respect to loop excision under LA. Since we found a high acceptance for LA in patients and colposcopists, we initiated a comparative study LA vs. GA: 322 patients underwent loop excision and selected their mode of anaesthesia: n = 206 LA vs. n = 116 GA. 114 patients of the feasibility study had to undergo loop excision and became part of the comparative study (n = 79 for the LA group, n = 35 for the GA group). All patients received a standardised questionnaire to document their pain score within 24 h after treatment on a visual analogue scale, i.e. VAS, between 0 and 100. 178 patients of the LA group and 80 patients of the GA group completed and returned the questionnaire and form the cohort for our comparison of LA vs. GA. With 191 of these 258 patients, i.e. 74%, a telephone survey was performed to ask for patient satisfaction and the rates of recurrence after a mean interval of 1 year post surgery. We postulate that there will be no clinically relevant significant difference in satisfaction and postoperative pain between patients in the LA group and the GA group. Results In the feasibility study , 90% (272 of 303) of patients diagnosed with HSIL or AIS were considered eligible for LA by their colposcopists. 75% (227 of 303) of patients were open to loop excision under LA. In the comparative study , 63 of 206 women of the LA group were interviewed preoperatively: 89% would accept a pain score above 20 during the procedure, 33% a pain score above 50 and 11% of max. 20. Postoperatively, the median VAS pain score for loop excision under local anaesthesia was 13.1 in 178 patients, and pain during injection of local anaesthesia was 20.9 (p < 0.001). The VAS pain score 20 minutes post surgery did not differ significantly between 178 patients after local anaesthesia versus 80 patients after general anaesthesia (p = 0.09). The surgeons estimated the patient's pain significantly less than the patients themselves with an underestimate of -14.63 points on the VAS (p < 0.001). Within 7 days following loop excision under LA, 95.5% of 178 patients would choose local anaesthesia as their preferred method for a potential repeat loop excision, 8.8% of which would like additional painkillers, and 4.5% would choose general anaesthesia.In a telephone follow-up survey of 133 women from the LA group after a mean of 12 months post surgery, 97% were "satisfied" or "very satisfied" with the treatment carried out. For patient satisfaction and postoperative pain, no clinically relevant significant difference was seen between the LA and the GA group.The rate of secondary bleeding (6.7% vs. 8.1%, p = 0.72), recurrence of HSIL/AIS (3.6% vs. 5.2%, p = 0.62), and the distribution of the histopathological R status (R0 89.5% vs. 81.1%, p = 0.73; R1 5.3% vs.12.2%, p = 0.57, Rx 4.1% vs. 5.4%, p = 0.65) showed no significant difference when comparing the LA group versus the GA group. Conclusion Following loop excision under local anaesthesia, more than 95% of patients would choose this method again for repeat surgery. One year post surgery, 97% of the patients were "satisfied" or "very satisfied" with the treatment under local anaesthesia. Offering local anaesthesia for loop excision to patients should be mandatory and included in current guidelines.
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Affiliation(s)
| | - Anja Petzel
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | - Anne Jülicher
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | - Anna Jonas
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | | | - Natalia Choly
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | | | - Jan Porthun
- NTNU – Technisch-Naturwissenschaftliche Universität Norwegens, Campus Gjøvik, Gjøvik, Norway
| | | | | | - Andreas M. Kaufmann
- Klinik für Gynäkologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CVK, Berlin, Germany
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Wang Z, Wang F, Xing Y, Jiang X, Ding Z, Li Y, Tang L. Efficacy of nitrous oxide in adults undergoing puncture biopsy: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0286713. [PMID: 37279243 DOI: 10.1371/journal.pone.0286713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Nitrous oxide (N2O) with rapid analgesic effect is often used to relieve pain induced by diagnostic procedures. This review was conducted to evaluate the efficacy and safety of N2O in patients undergoing puncture biopsy. METHODS We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus and the ClinicalTrials.gov up to March, 2022. Randomized controlled trials (RCTs) were included if they investigated the effect of N2O in adults undergoing puncture biopsy. The primary outcome was pain score. Secondary outcomes included anxiety score, patient satisfaction and side effects. RESULTS Twelve RCTs with 1070 patients were included in the qualitative review, of which eleven RCTs were included in the meta-analysis. Pooled analysis suggested that compared with the controls (placebo, lidocaine and midazolam), N2O had better analgesic effect (MD -1.12, 95% CI -2.12 to -0.13, P = 0.03; I2 = 94%). In addition, N2O significantly alleviated patient anxiety (MD = -1.79, 95% CI -2.41 to -1.18, P<0.00001; I2 = 0%) and improved patient satisfaction (MD 1.81, 95% CI 0.11 to 3.50, P = 0.04; I2 = 92%). There was no significant difference regrading the risk of nausea (RR 2.56; 95% CI 0.70 to 9.31, P = 0.15; I2 = 0%), headache (RR 0.62, 95% CI 0.17 to 2.33, P = 0.48; I2 = 46%), dizziness (RR 1.80, 95% CI 0.63 to 5.13, P = 0.27; I2 = 0%) or euphoria (RR 2.67, 95% CI 0.81 to 8.79, P = 0.11; I2 = 8%) between the N2O group and the control group. CONCLUSION The present review suggested that N2O might be effective for pain management in patients undergoing puncture biopsy.
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Affiliation(s)
- Ziyang Wang
- School of Nursing, Weifang Medical University, Weifang, China
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Fei Wang
- Department of Anesthesiology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Yihui Xing
- School of Nursing, Weifang Medical University, Weifang, China
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Xiaochen Jiang
- School of Nursing, Weifang Medical University, Weifang, China
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Zhiguo Ding
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Yuxiang Li
- Ningxia Medical University, Yinchuan, China
| | - Lu Tang
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
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Marchand GJ, Masoud AT, Ware K, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Coriell C, Ulibarri H, Parise J, Arroyo A, Chen YC, Pierson M, Rafie R, Sainz K. A Systematic Review and Meta-Analysis of the Effect of Intraoperative Bupivacaine in Gynaecologic Surgery After 24 Hours or 9 Half-Lives. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1279-1287. [PMID: 34293514 DOI: 10.1016/j.jogc.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review all high quality available evidence regarding the effect of intraoperative bupivacaine 24 hours (or 8.9 half-lives) after intraoperative administration at time of gynaecologic surgery and to ascertain whether a second mechanism of action, beyond the initial prevention of sodium channel depolarization and blockade of nerve impulses, may be occurring. DATA SOURCES We searched all major databases with an algorithm designed to include all randomized trials that used any form of local bupivacaine, regardless of dose or route of administration, at the time of any gynaecologic surgery and compared its use with saline placebo. RESULTS As expected, we found that bupivacaine showed a significant improvement for all gynaecologic surgeries with respect to pain intensity at 6 hours after surgery when compared with a saline group (mean difference [MD] -1.28; 95% CI -1.96 to -0.61], P = 0.07). We also found a significant difference at 24 hours after surgery, giving evidence to the possibility of a second mechanism of action (MD -0.57; 95% CI -1.10 to -0.05], P = 0.01). Further subgroup analysis for pain levels at 24 hours showed significant decreases in pain for the laparoscopy (MD -0.74; 95% CI -0.93 to -0.54, P < 0.01) and laparotomy (MD -2.60; 95% CI -2.93 to -2.27, P < 0.01)) subgroups but not for the vaginal hysterectomy (MD 0.20; 95% CI -0.69 to 1.09, P = 0.66) or prolapse surgery (MD -0.11; 95% CI -0.41 to 0.19, P = 0.48) subgroups. There was no significant difference with respect to the length of hospital stay (MD -0.11; 95% CI -0.59 to 0.38, P = 0.67). CONCLUSION As expected, bupivacaine significantly reduced visual analog pain scores when compared with placebo at 6 hours after surgery, but also showed a significant difference at 24 hours after surgery, giving evidence of a second mechanism of action following the initial sodium channel blockade.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona.
| | - Ahmed Taher Masoud
- Fayoum University Faculty of Medicine, Qesm Al Fayoum, Faiyum, Faiyum Governorate, Egypt
| | - Kelly Ware
- International University of the Health Sciences, Mesa, Arizona
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Yu-Chun Chen
- Midwestern University College of Osteopathic Medicine, Mesa, Arizona
| | - Maria Pierson
- Midwestern University College of Osteopathic Medicine, Mesa, Arizona
| | - Rasa Rafie
- Rocky Vista University College of Osteopathic Medicine, Mesa, Arizona
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
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Gonzalez R, Dunn A, Williams L, Weber J, Erkanli A, Havrilesky LJ, Selim MA. Histopathology after lidocaine/prilocaine cream administration for vulvar biopsy. J Cutan Pathol 2021; 48:1239-1245. [PMID: 33846983 DOI: 10.1111/cup.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/15/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Case series have described disruptive histopathologic changes following lidocaine/prilocaine cream anesthetic for biopsies. METHODS A study of histopathologic changes was performed following a randomized trial comparing topical lidocaine/prilocaine cream to 1% lidocaine injection anesthesia for vulvar biopsy. Histopathology was reviewed by two independent dermatopathologists blinded to the type of anesthetic. Specimens were scored on six histopathologic criteria described in the literature. Individual scores for each histopathologic feature and the total score across features were compared between the two groups using marginal models with generalized estimating equations. RESULTS Of 37 specimens reviewed, 19 were randomized to lidocaine/prilocaine cream and 18 to 1% lidocaine. Subjects exposed to lidocaine/prilocaine had the following odds of histopathologic changes, relative to lidocaine-exposed subjects: acantholysis (odds ratio 2.48; 95% confidence intervals [CI] 0.51, 12.06), clefting (2.42; 0.64, 9.14), pallor/necrosis (1.13; 0.28, 4.50), spongiosis (0.71; 0.18, 2.85), and papillary dermal edema (1.17; 0.41, 3.29). Total scores were not significantly different between treatment arms (risk ratio 0.98; 0.71, 1.35). CONCLUSION This histopathologic analysis of a randomized trial between lidocaine/prilocaine cream and injected lidocaine as anesthesia for vulvar biopsy shows the absence of significant disruptive histopathologic features secondary to the type of anesthetic. Additional studies in different clinical contexts are warranted.
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Affiliation(s)
- Rafael Gonzalez
- Division of Gynecologic Oncology, Duke University, Durham, North Carolina, USA
| | - Andrew Dunn
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Logan Williams
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Jeremy Weber
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Laura J Havrilesky
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
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