Interpretability of Excisional Biopsies of the Cervix: Cone Biopsy and Loop Excision

Abstract

Limited data are available on the attitudes of gynecologists regarding mode of hysterectomy for benign indications. This cross-sectional study used a postal questionnaire to assess attitudes of members of the Swedish Society of Obstetrics and Gynecology toward mode of benign hysterectomy. The choices of mode of hysterectomy were total abdominal hysterectomy, subtotal abdominal hysterectomy, laparoscopic or laparoscopically-assisted hysterectomy, and vaginal hysterectomy (VH). Participants were asked questions about their gender, seniority, place of work, and surgical experience, including years in the specialty and annual number of hysterectomies performed to determine whether differences in such factors influenced their choice of mode. The gynecologists were asked to choose between these modes for 3 scenarios with different benign clinical conditions. Scenario A was a normal to slightly enlarged uterus with no uterine descensus and no previous cervical dysplasia. Scenario B differed from the first scenario only in that there had been previous treatment of cervical dysplasia up to moderate degree (CIN II). In scenario C, there was an enlarged uterus (larger than gestational week 12-13) with no uterine descensus and no previous cervical dysplasia. The respondents were also asked to give their personal view of how the overall distribution should be for the different modes of benign hysterectomy. Multiple logistic regression and multivariate models of covariance were used for unadjusted and adjusted analyses.The participants chose VH in general or when the uterus was of normal size or slightly enlarged (scenarios A and B), and recommended abdominal hysterectomy and subtotal abdominal hysterectomy when the uterus was enlarged (scenario C). More male gynecologists than female gynecologists favored VH as a personal preference. There were significant variations in choice and suggested distribution of mode for place of work, seniority, and annual number of hysterectomies performed. More than 50% of the participants recommended the minimally-invasive methods of vaginal and laparoscopic hysterectomy as their overall personal choice for suggested distribution.These findings indicate that choice of mode of hysterectomy for benign conditions among gynecologists is significantly influenced by personal preference based on differences in gender, place of work, seniority, and annual number of hysterectomies, and does not appear to strictly follow evidence-based recommendations. EDITORIAL COMMENT(Hysterectomy is one of the most common operations done in the United States. These days there is quite a variety of techniques for hysterectomy and we have discussed the advantages of one approach or another on these pages many times. As I analyze the results of this article on hysterectomy preferences from Sweden, I think there are 3 different levels of preferences for types of hysterectomy:(1) what is your "theoretical" preference? (this study, where you respond to a hypothetical scenario);(2) what is your "actual" practice? (what was t...

Shimodaira-Taniguchi Conization Method: Its Utility and Reliability

“…The LEEP has been associated with an increased number of specimens, which limits interpretability, and an increased number of positive margins. 12,13 Ideally, conization should yield a single interpretable specimen and disease-free margins. Miroshnichenko et al 13 reported that LEEP was less likely to yield a single intact specimen and that an increase in the number of specimens obtained had a statistically significant negative effect on pathologic interpretability.…”

Treatment of high‐grade squamous intraepithelial lesions in an area of Thailand with a high incidence of cervical cancer

“…Multiple-pass LEEP is not an uncommon practice, but it has been reported as a risk factor for unevaluable margins [6,7]. In the present study, the rate of multiple passes (nearly 40%) was twice the maximum rate recommended (20%) [4].…”

Cervical Cancer Screening

“…The panel favored the use of CKC for patients in whom microinvasive cervical cancer was suspected. 51 The LEEP has been associated with a cautery artifact that may compromise the pathologic evaluation of the tissue specimen. Diagnosis of microinvasive or invasive cancer at cervical biopsy requires treatment according to the NCCN Guidelines for Cervical Cancer (in this issue and at www.NCCN.org).…”

“…CKC is performed for microinvasive biopsy findings; CKC or LEEP can serve as definitive treatment if the lesion is confirmed to be intraepithelial. 51 A diagnosis of microinvasive or invasive cancer on cervical biopsy, LEEP, or CKC requires treatment according to the NCCN Guidelines for Cervical Cancer (in this issue and at www.NCCN.org).…”