Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

Carvalho, Jesus Paula; Carvalho, Filomena Marino; Pincerato, Kátia Maciel

doi:10.1590/s0041-87812001000600002

Cited by 10 publications

(10 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, incomplete excision of CIN may result in a significant problem when opting for colposcopic follow-up on an outpatient basis, since patients living far from healthcare centers are often unable to comply with scheduled visits, which ultimately facilitates progression of the disease to more advanced stages [11]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Positive Endocervical Margins at Conization: Repeat Conization or Colposcopic Follow-Up? A Retrospective Study

et al. 2015

View full text Add to dashboard Cite

BackgroundThe presence of residual cervical lesions was evaluated in patients submitted to repeat conization due to a finding of positive endocervical margins in a previous loop electrosurgical excision procedure (LEEP) specimen. In addition, the correlation between the presence of a residual lesion and risk factors for cervical cancer, and the use of repeat conization as first-choice treatment were analyzed.MethodsThis retrospective study included 44 patients submitted to repeat cervical conization or total hysterectomy following a finding of affected endocervical margins in LEEP specimens. The risk factors analyzed in relation to the presence of residual lesions were age, smoking, cone depth, glandular involvement and the histopathology findings of cervical intraepithelial neoplasia (CIN) 1, CIN 2 or CIN 3/carcinoma in situ. The Chi-square test and the Mann-Whitney t-test were used, with significance defined at P < 0.05.ResultsResidual lesions were found in 23/44 patients (52.3%), with 3/23 cases (13.0%) being compatible with invasive squamous cell carcinoma. Of the 23 patients, six (26.1%) were submitted to total hysterectomy, with one case being compatible with a moderately differentiated invasive squamous cell carcinoma. Two patients with a histopathology finding of CIN 3/carcinoma in situ in the previous LEEP specimen were diagnosed with invasive squamous cell carcinoma in the repeat conization specimen. Residual lesions were not significantly associated with the risk factors evaluated.ConclusionsIn view of the high frequency of residual disease found when positive endocervical margins were found in LEEP specimens, the indication for repeat cervical conization rather than colposcopic follow-up is viable and justified. Indeed, since the presence of a residual lesion and its progression in the cervical canal are more difficult to screen and control, patients unable to comply with regular colposcopic follow-up could benefit from repeat conization when trying to avoid a potentially negative outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Carvalho et al [11] evaluated patients submitted to cone/frozen section examination followed by hysterectomy and reported that the depth of the cone ranged from 1 to 2.5 cm, with 64% of positive margins. Of these, residual disease was found in the uterus in 68.8% of cases.…”

Section: Discussionmentioning

confidence: 99%

Positive Endocervical Margins at Conization: Repeat Conization or Colposcopic Follow-Up? A Retrospective Study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…However, since a discrepancy may no longer be detectable on inaccurate therapy, most gynecologists and pathologists do not agree with applying FSE after CKC (Cold Knife Conization). Carvalho et al diagnosed two cases of microinvasive carcinoma as CIN with less than 2 mm stromal invasion by FSE (8). In the study by Hasanzadeh et al (7) the discrepancy rate was 25% (5:20), where FSE revealed CIN 3 in one patient, whereas paraffin section showed invasive carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…The role of FS examinaion (FSE) in CIN has not received much attention. Some researchers have discussed high concordance with the definitive paraffin examination in grading the lesion, but there are few studies evaluating the role of FSE of resection margin status (7)(8)(9). In addition, there are conflicting reports on the efficiency of FSE of the cone specimen in evaluating the margin status.…”

Section: Introductionmentioning

confidence: 99%

Frozen Section Evaluation of the Cacone Margin Status in High-Grade Cervical Intraepithelial Neoplasia

Ganjooei¹,

Vahedpoorfard²,

Rafiezadeh³

et al. 2015

Women's Health Bull

View full text Add to dashboard Cite

Background: Meticulous examination of frozen section of cone specimens is required to precisely evaluate the resection margin status and rule out invasion in cases with high-grade cervical intraepithelial neoplasia (CIN). Objectives: The aim of the present study was to determine the role of frozen section examination (FSE) of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade CIN. Patients and Methods:This cross-sectional study was performed on 38 patients with high-grade CIN undergoing conization biopsy at Imam Hossein hospital in Tehran from April 2012 through May 2013. Then, FS examination was performed for all patients and the results obtained were compared with those of permanent paraffin sections. Results: Thirty-three (86.8%) out of 38 patients had the same results in frozen and permanent sections of cone biopsy margin specimens (P = 1). Two out of 33 (6.1%) patients had frozen and permanent positive margins and 31 (93.9%) patients had negative frozen and permanent margins. Among the other 5 patients (13.2%), 2 had positive frozen margins and negative permanent margins and 3 patients had negative frozen margins and positive permanent margins. Diagnostic accuracies in cone margin and lesion grading were 63.1% and 44.7%, respectively. Conclusions: In conclusion, in high-grade CIN, FS examination was a rapid, reliable and cost-effective means of evaluating cervical conization specimens.

show abstract

“…Previous studies of this approach have all been from academic centers in the United States [4, 7, 8] and other countries [5, 6, 9], and presumably pathologists at academic centers had extra training or interest in gynecologic malignancies. At MD Anderson Cancer Center, all specimens were reviewed by 1 of 6 pathologists subspecialized in the area of gynecologic pathology and therefore spend the majority of their time reviewing gynecology cases.…”

Section: Discussionmentioning

confidence: 99%

Utility of conization with frozen section for intraoperative triage prior to definitive hysterectomy

Martinelli

Schmeler

Johnson³

et al. 2012

Gynecologic Oncology

View full text Add to dashboard Cite

Objective-To review our experience with conization with intraoperative frozen section analysis and to compare results from our tertiary cancer center with those from 2 community hospitals. Luke's Episcopal Hospital-were reviewed. Findings on pathologic analysis of frozen sections, permanent loop electrosurgical excisional procedure/conization specimens, and hysterectomy specimens were compared for each patient, and results from the cancer center were compared to those from the community hospitals. Methods-TheResults-One hundred fifty-three patients met the inclusion criteria. Rates of accuracy of conization with frozen section analysis in predicting definitive pathologic findings were as follows: cervix with no residual disease after prior extirpative procedure 96.5% (95% CI 86.9-100%); cervical squamous carcinoma in situ, 95.4% (95% CI 84.5-100%); cervical adenocarcinoma in situ, 98.7% (95% CI 92.7-100%); microinvasive carcinoma, 97.4% (95% CI 90.1-100%); and invasive carcinoma ≥ 3 mm, 100%. Most importantly, conization with frozen section analysis was 100% accurate for triaging patients to simple or radical hysterectomy. Finally, this approach performed equally well in the cancer center with subspecialized pathologists and the 2 community hospitals with general pathologists.Conclusion-Conization with frozen section analysis is an effective technique for intraoperative triage of patients to immediate simple or radical hysterectomy and can be accurately performed in both academic and community hospitals.

show abstract

Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

Cited by 10 publications

References 1 publication

Positive Endocervical Margins at Conization: Repeat Conization or Colposcopic Follow-Up? A Retrospective Study

Positive Endocervical Margins at Conization: Repeat Conization or Colposcopic Follow-Up? A Retrospective Study

Frozen Section Evaluation of the Cacone Margin Status in High-Grade Cervical Intraepithelial Neoplasia

Utility of conization with frozen section for intraoperative triage prior to definitive hysterectomy

Contact Info

Product

Resources

About