Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment

Luesley, D. M.; McCRUM, A.; Terry, P. B.; Wade-Evans, T.; Nicholson, H. Oliphant; Mylotte, M. J.; Emens, J. M.; Jordan, J. A.

doi:10.1111/j.1471-0528.1985.tb01068.x

Cited by 124 publications

(36 citation statements)

References 8 publications

(5 reference statements)

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“…However, they considered that their small sample of cases was a limiting factor (n = 10, out of 164 patients). Luesley et al 5 stated that cervical stenosis was more common in patients who had higher cones (more than 2.5 cm height) and proposed that the height of the cervical canal to be removed should be measured for the size of the cone, in order to be as small as possible, thus reducing the complications.…”

Section: Lletz = Large Loop Excision Of the Transformation Zone; Rr =mentioning

confidence: 99%

“…Furthermore, it causes limitations in relation to the cytological and colposcopic follow-up after treatment for preinvasive cervical diseases, thereby making it diffi cult for residual or recurrent diseases to be diagnosed. 5,6 There is no consensus in the literature regarding the defi nition of cervical stenosis. Because of the different defi nitions used, the incidence observed by each author has also varied (from 0 to 25.9%).…”

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confidence: 99%

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Cervical stenosis following electrosurgical conization

et al. 2008

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CONTEXT AND OBJECTIVE: Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. DESIGN AND SETTING:Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. METHODS:This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confi dence intervals (95%). Levels of 5% were considered signifi cant.RESULTS: 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66% and the incidence density was 3.3/1,000 patients-month. CONCLUSIONS:We did not fi nd associations between the variables for stenosis. However, we observed borderline signifi cance levels relating to hemorrhagic complications before and after the operation (p = 0.089).

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Section: Lletz = Large Loop Excision Of the Transformation Zone; Rr =mentioning

confidence: 99%

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confidence: 99%

Cervical stenosis following electrosurgical conization

et al. 2008

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“…2 Cone biopsy can also rarely lead to cervical stenosis followed by hematometra formation. 3,4 Cases of hematometra formation after cesarean section have been reported in literature. Multiple hemostatic sutures at the placental bed in a case of placenta previa section can lead to synechiae formation, cervical stenosis and hematometra.…”

Section: Case Reportmentioning

confidence: 99%

Cervical Stenosis and Hematometra : A Rare Complication of Cesarean Section and VVF Repair

Vishwekar¹,

Sawant²

2015

jemds

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“…Given that screening has so little effect on incidence in this age group and the fact that the age-specific rate is not much greater anywhere in the world, we doubt that the number would have been appreciably larger in the absence of screening. Furthermore, the extremely small number of cancers prevented (if any) by screening under the age of 25 years must be balanced against the extremely high rates of cytological abnormality (15%) and unnecessary treatment, with a complication rate of cervical stenosis in up to 3% of those treated (Luesley et al, 1985).…”

Section: Sirmentioning

confidence: 99%

Reply: The value of case—control audits of screening

2004

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Dr Herbert makes a number of points about our paper that we shall address in turn. Her basic thesis is that when coverage is high, comparison of cervical smear histories in women with and without cancer does not provide useful estimates of the effectiveness (or even the relative effectiveness) of screening at different ages. We strongly disagree. Although observational studies are subject to bias, we do not believe that this can explain the substantial differences in effectiveness that we observed across different age groups. The percentage of women with a screening smear is almost identical in cases and controls aged 20 -29 years (74.3 vs 74.8%), underlying the lack of effectiveness of screening in this group compared to women aged 45 -64 years, in whom coverage is much greater among controls (81.5 vs 59.0%).We agree that some of the screening in our study dates back to the late 1980s and that a variety of quality assurance measures have been introduced since. However, in general, one would expect any advantage of 3-yearly screening over 5-yearly screening to diminish as the quality of screening improves. Table 1b provides an analysis restricted to cases (and their controls) diagnosed since January 1995. The results are quantitatively similar (and qualitatively unchanged) to those presented in our paper (Table 1a).Although it is true that screening coverage improved considerably between 1987 and 1993, the claim that, in 1994 -1995, over 90% of women had been screened is erroneous. This figure is based on the proportion who had been (or were due to be) sent an invitation, not the proportion actually screened. No data exist for the proportion of women aged 25 -64 years in 1994 who had ever been screened. However, it is unlikely to be that much greater than the proportion screened in the previous 5 years (85.7%), since coverage was low prior to 1990 and women screened then were likely to return for screening when invited. Additionally, the relevance of this to comparing 3-vs 5-yearly screening is dubious.We do not believe that cases with unknown stage were more likely to be fully invasive. Most Health Authorities provided information on stage from all or none of the cases for a given year. Restricting analysis to sources that provided complete staging on all cases submitted made little difference to the results (Table 1c).We agree that due to the poor sensitivity of cervical cytology, the number of previous recent smears is also important. This was illustrated in Tables 3 and 4, in which the added affect of having more than one previous smear was estimated. The results further support our main finding that screening is less effective in younger women. The additional relative benefit of a second negative smear in women aged 20 -39 years was only 1.03 compared to 1.32 and 1.35 for women aged 40 -54 and 55 -69 years, respectively.Dr Herbert points out that in 1998 over 4000 cases of CIN3 were detected in UK women under 25 years. What she does not say is that this compares with fewer than 50 cases of invasive cancer u...

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Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment

Cited by 124 publications

References 8 publications

Cervical stenosis following electrosurgical conization

Cervical stenosis following electrosurgical conization

Cervical Stenosis and Hematometra : A Rare Complication of Cesarean Section and VVF Repair

Reply: The value of case—control audits of screening

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