Loop electrosurgical excision procedures for cervical dysplasia: Experience in a community hospital

Krebs, H B; Pastore, Lucia; Helmkamp, B. Frederick

doi:10.1016/0002-9378(93)90078-w

Cited by 40 publications

(36 citation statements)

References 8 publications

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“…14,17 The amount of thermal artifact can also reduced by having an highly experienced operator perform the LEEP procedure. 9,12 However, this finding is clearly contradicted by articles directed at the family practitioner, one of which proclaims, "Basic technique can be taught in a conference setting in 1 day, and this training could be incorporated into existing colposcopy workshops for family physicians. With a relatively low cost for a state-of-the-art LEEP unit, it is cost-effective for even infrequent use."…”

Section: Discussionmentioning

confidence: 57%

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The Case for Cytologic Follow-up After LEEP

Hanau

Bibbo²

1997

Acta Cytologica

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Section: Discussionmentioning

confidence: 57%

“…9,[11][12][13]15,18,21,22 These include items pertaining to time, blood loss and number of complications, all easily quantified. The main advantage of the LEEP biopsy over ablative techniques, obtaining a specimen for histopathologic examination, however, deserves close scrutiny.…”

Section: Discussionmentioning

confidence: 99%

The Case for Cytologic Follow-up After LEEP

Hanau

Bibbo²

1997

Acta Cytologica

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“…Although these methods can provide histologic information including the depth of invasion and the involvement of the surgical margins, several randomized trials have demonstrated that there were no statistically signifi cant differences in cure rates for CIN among these methods [4,8,9] . Krebs et al [3] demonstrated that fragmentation and cautery damage interfered with the orientation of tissue and with histologic evaluation of the margins in 19% of cases. Mathevet et al [10] showed that thermal artifact induced by coagulation prohibited evaluation of cone margins from specimens in 38% of patients who underwent conization by laser and in 31% of those with conization by loop.…”

Section: Discussionmentioning

confidence: 98%

“…Because it requires general anesthesia and possibly leads to some complications, traditional cold knife conization has been largely replaced by laser or loop conization. However, the coagulation artifact caused by laser or loop, and the diffi culty in the orientation of the removed tissue may make histologic evaluation diffi cult or lead to diagnostic inaccuracies [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and therapeutic cold knife conization for cervical intraepithelial neoplasia

Dai

Duan

Lin

et al. 2010

Clin. Oncol. Cancer Res.

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OBJECTIVE To evaluate the diagnostic and therapeutic effi cacy of using cold knife conization for cervical intraepithelial neoplasia (CIN). METHODS We retrospectively analyzed 186 cases with CIN diagnosed and treated in our hospital; compared the histologic diagnoses from cervical conization and from colposcopic multiple punch biopsies, and then evaluated their postoperative histologic fi ndings and clinical outcomes. RESULTS Of the 186 cases, there was a correlation in histologic findings between cervical conization and colposcopic multiple punch biopsies in 138 cases (74.2%), and there was no correlation in the other 48 cases (25.8%). Incomplete excision was performed in 8 cases (4.3%), but the failure rate was only 1.1%; the cure rate was 98.9%. Five cases with early invasive cancer were found. Eleven patients underwent subsequent hysterectomy. The main complications associated with conization were hemorrhage and cervical stenosis. Bleeding occurred in 8 (4.3%) of the patients, and cervical stenosis occurred in 3 (1.6%). CONCLUSION Cervical intraepithelial neoplasia was diagnosed more accurately using conization than by colposcopic multiple punch biopsies. Conization can also play an important role in the treatment for CIN. If properly performed, the procedure has a low risk of complications. It can provide an accurate histologic representation of the disease process, and be curative in most cases.

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“…2 Disadvantages of the LEEP include residual dysplasia at the margins of the specimen, thermal artifact, and fragmentation of the specimen. [3][4][5][6] These factors can increase the risk of recurrence of dysplasia after excision and can negatively affect the ability of the pathologist to evaluate the specimen. [7][8][9][10] The FCBE was designed to minimize the disadvantages of the LEEP by increasing the support and stabilization of the excising stainless steel wire.…”

mentioning

confidence: 99%

Treatment of Cervical Dysplasia with the Fischer Cone Biopsy Excisor in a Family Medicine Office: A Case Series

Mulhem

Kennedy²,

Lick³

2010

The Journal of the American Board of Family Medicine

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Purpose: The purpose of this study was to evaluate the use of the Fischer cone biopsy excisor (FCBE) as the primary electrode for treatment of cervical dysplasia in a family medicine office.Methods: Retrospective analysis of cervical electrosurgical excision procedures in patients with cervical intraepithelial neoplasia (CIN) performed in our Family Medicine Center between 2002 and 2005.Results: We reviewed 91 cases. Indication for excision was >CIN II in 86.8% of the patients. In the FCBE group (n ‫؍‬ 86), 95% of the specimen margins were negative for dysplasia, 90% had no reported thermal artifact, and 81% were submitted unfragmented. In the FCBE and the loop electrosurgical excision procedure (LEEP) group (n ‫؍‬ 5), 4 of the 5 specimens' margins were negative for dysplasia. Reported complications included palpitations or flushing during cervical block (32%), pain (9%), and heavy bleeding (3%).Conclusion Treatment of cervical dysplasia in an outpatient setting involves either electrosurgical excision or cryotherapy of the cervical transformation zone. Two electrosurgical excision methods are most commonly used: the loop electrosurgical excision procedure (LEEP) and the Fischer cone biopsy excisor (FCBE). The LEEP was introduced in 1989, 1 followed by the FCBE in 1994. 2 Disadvantages of the LEEP include residual dysplasia at the margins of the specimen, thermal artifact, and fragmentation of the specimen.3-6 These factors can increase the risk of recurrence of dysplasia after excision and can negatively affect the ability of the pathologist to evaluate the specimen. 7-10The FCBE was designed to minimize the disadvantages of the LEEP by increasing the support and stabilization of the excising stainless steel wire. The FCBE consists of a straight stainless steel electrode attached to an insulated shaft and stop arm. After activation the electrode is inserted into the cervix until the stop arm touches the cervix. The shaft is rotated 360 degrees and a cone shaped cervical specimen is cut. Seven sizes of the wire are available, with different lengths and widths. 2,11 Many articles describe family physicians' experience with the use of LEEP to treat cervical dysplasia.12-15 However, there is currently no published article that describes the use of the FCBE for this purpose in a family medicine office. In this study we evaluated the use of the FCBE in a family medicine office for the treatment of

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Loop electrosurgical excision procedures for cervical dysplasia: Experience in a community hospital

Cited by 40 publications

References 8 publications

The Case for Cytologic Follow-up After LEEP

The Case for Cytologic Follow-up After LEEP

Diagnostic and therapeutic cold knife conization for cervical intraepithelial neoplasia

Treatment of Cervical Dysplasia with the Fischer Cone Biopsy Excisor in a Family Medicine Office: A Case Series

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