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

Martinelli, Fabio; Schmeler, Kathleen M.; Johnson, Chelsea; Brown, Jubilee; Euscher, Elizabeth D.; Ramírez, Pedro T.; Frumovitz, Michael

doi:10.1016/j.ygyno.2012.07.101

Cited by 8 publications

(4 citation statements)

References 13 publications

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“…Our group previously reported a single-step procedure with conization and frozen section for intra-operative triage of simple versus radical hysterectomy in 150 women with stage IA1 disease. 35 However, further study is needed to determine the safety of this single-step approach for patients potentially eligible for conservative surgery, particularly in institutions without specialized pathology services as well as in low-and middle-income countries.…”

Section: Original Researchmentioning

confidence: 99%

ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer

Schmeler

Pareja

Blanco

et al. 2021

Int J Gynecol Cancer

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102

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ObjectiveThe objective of the ConCerv Trial was to prospectively evaluate the feasibility of conservative surgery in women with early-stage, low-risk cervical cancer.MethodsFrom April 2010 to March 2019, a prospective, single-arm, multicenter study evaluated conservative surgery in participants from 16 sites in nine countries. Eligibility criteria included: (1) FIGO 2009 stage IA2–IB1 cervical carcinoma; (2) squamous cell (any grade) or adenocarcinoma (grade 1 or 2 only) histology; (3) tumor size <2 cm; (4) no lymphovascular space invasion; (5) depth of invasion <10 mm; (6) negative imaging for metastatic disease; and (7) negative conization margins. Cervical conization was performed to determine eligibility, with one repeat cone permitted. Eligible women desiring fertility preservation underwent a second surgery with pelvic lymph node assessment, consisting of sentinel lymph node biopsy and/or full pelvic lymph node dissection. Those not desiring fertility preservation underwent simple hysterectomy with lymph node assessment. Women who had undergone an ‘inadvertent’ simple hysterectomy with an unexpected post-operative diagnosis of cancer were also eligible if they met the above inclusion criteria and underwent a second surgery with pelvic lymph node dissection only.Results100 evaluable patients were enrolled. Median age at surgery was 38 years (range 23–67). Stage was IA2 (33%) and IB1 (67%). Surgery included conization followed by lymph node assessment in 44 women, conization followed by simple hysterectomy with lymph node assessment in 40 women, and inadvertent simple hysterectomy followed by lymph node dissection in 16 women. Positive lymph nodes were noted in 5 patients (5%). Residual disease in the post-conization hysterectomy specimen was noted in 1/40 patients—that is, an immediate failure rate of 2.5%. Median follow-up was 36.3 months (range 0.0–68.3). Three patients developed recurrent disease within 2 years of surgery—that is, a cumulative incidence of 3.5% (95% CI 0.9% to 9.0%).DiscussionOur prospective data show that select patients with early-stage, low-risk cervical carcinoma may be offered conservative surgery.

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Section: Original Researchmentioning

confidence: 99%

ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer

Schmeler

Pareja

Blanco

et al. 2021

Int J Gynecol Cancer

Self Cite

102

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“…Most endometrial cancers are early stage, low grade, and of endometrioid histology (type I), with a 5-year survival of greater than 85% 4. Uterine serous cancer (USC)3 and serous endometrial intraepithelial carcinoma (EIC) (also known as minimal uterine serous cancer [MUSC]) comprise a highly aggressive histologic type of endometrial cancer (type II). Although type II cancer represents less than 10% of all endometrial cancers, it accounts for more than 50% of relapses and deaths attributed to endometrial carcinoma 5–7.…”

Section: Introductionmentioning

confidence: 99%

Serous endometrial intraepithelial carcinoma: a case series and literature review

Pathiraja¹,

Dhar²,

Haldar³

2013

CMAR

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BackgroundMinimal uterine serous cancer (MUSC) or serous endometrial intraepithelial carcinoma (EIC) has been described by many different names since 1998. There have been very few cases reported in literature since EIC/MUSC was recognized as a separate entity. The World health Organization (WHO) Classification favors the term serous EIC. Although serous EIC is confined to the uterine endometrium at initial histology diagnosis, a significant number of patients could have distal metastasis at diagnosis, without symptoms. Serous EIC is considered as being the precursor of uterine serous cancer (USC), but pure serous EIC also has an aggressive behavior similar to USC. It is therefore prudent to have an accurate diagnosis and appropriate surgical staging. There are very few published articles in literature that discuss the pure form of serous EIC. The aim of this series is to share our experience and review evidence for optimum management of serous EIC.Patients and methodsWe report a series of five women treated in our institute in the last 3 years. We reviewed the relevant literature on serous EIC and various management strategies, to recommend best clinical practice.ConclusionPure serous EIC is a difficult histopathological diagnosis, which requires ancillary immunohistochemical staining. It can have an aggressive clinical behavior with early recurrence and poor survival. Optimum surgical staging, with appropriate adjuvant treatment, should be discussed when treating these patients.

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“…Стандартне лікування ЦІН являє собою використання деструкційних та ексцизійних методик у залежності від ступеня і розміру патологічних змін ШМ. Зазвичай ексцизійне лікування ЦІН показане лише при HSIL не тільки через ризик акушерських ускладнень в подальшому, а й тому, що більшість LSIL у молодих жінок регресують самостійно [19]. Дані мета-аналізу вказують на те, що всі хірургічні методи лікування ЦІН (кріо деструкція, лазерна деструкція, електрокоагуляція, петльова та «холодноножева» ексцизія) мають низькі рівні ускладнень і, за винятком кріодеструкції, не мають суттєвої достовірної різниці в ризику виникнення рецидиву та резидуального захворювання [18,26,27].…”

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“…Дані мета-аналізу вказують на те, що всі хірургічні методи лікування ЦІН (кріо деструкція, лазерна деструкція, електрокоагуляція, петльова та «холодноножева» ексцизія) мають низькі рівні ускладнень і, за винятком кріодеструкції, не мають суттєвої достовірної різниці в ризику виникнення рецидиву та резидуального захворювання [18,26,27]. Всі види лікування передракової патології ШМ збільшують ризики передчасних пологів у подальшому, але аблятивне лікування має найменший вплив, тоді як у випадках ексцизії ризик передчасних пологів зростає прямо пропорційно глибині ексцизії [16][17][18][19] більше 5 мм при будь-якому ступені передракового ураження ШМ [16]. Особливої уваги потребує такий деструктивний метод лікування, як «холодна» атмосферна плазма -метод високочастотної електрохірургії, в якому енергія електромагнітного поля високої частоти передається на тканину безконтактно за допомогою струму іонізованого інертного газу при атмосферному тиску і майже амбієнтній температурі, тобто низькотемпературного факела плазми [14].…”

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Analysis of the results of combined treatment of cervix precancerous pathology in reproductive aged women

Гладчук¹,

Kashtalian²

2021

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Aim of the study. Comparative analysis of the results of cervical epithelial neoplasia (CIN) I and II levels (p16ink4a-negative) (LSIL in LAST terminology) treatment against the background of highly oncogenic HPV infection using cold plasma ablation and immunomodulatory therapy with Аllokin-alpha.Materials and methods. We examined 60 women who received treatment for CIN I and CIN II (p16ink 4A negative) at the Multidisciplinary Medical Center of Odessa National Medical University. All women were of reproductive age, had mild dysplasia, high-risk HPV infection (HPV 16, 18, 31, 45) and histological confirmation of CIN I and CIN II (p16ink 4A negative). The patients were divided into 2 groups: 1 (main) group consisted of 30 women who received cold plasma ablation of cervical dysplasia in combination with immunomodulatory therapy with Аllokin-alpha (1 mg subcutaneously every other day, 3 injections before surgery and 3 injections after ablation), Group 2 (control) consisted of 30 patients who received standard cold plasma ablative treatment without prescribing immunomodulators. All women underwent cytomorphological examination of the cervical epithelium, HPV testing by RealTime PCR and colposcopy with mandatory targeted biopsy at the preoperative stage.Results. The use of combined cold plasma ablative treatment of CIN I and CIN II (p16ink 4A negative) in combination with the administration of the immunomodulator Аllokin-alpha significantly reduced the duration of discharge after ablation to 5.44 ± 1.03 days (95% CI: 4.96–6.05), the timing of epithelialization is up to 29.31 ± 1.12 days (95% CI: 26.81–32.32), and to exclude cases of recurrence of genital warts and cervical keratosis. Chances of HPV elimination 6 months after treatment (OR – 5.48; 95% CI: 1.56–29.03; p = 0.0075) and 12 months after treatment (OR – 15.48; 95% CI : 2.05–136.45; p = 0.0094), significantly higher with the combined with immunomodulation method of treatment, in contrast to only cold plasma ablation.Conclusion. Combined, with the use of cold plasma ablation and immunomodulation by perioperative management of Аllokin-alpha, LSIL treatment against the background of highly oncogenic HPV infection in women of reproductive age is accompanied by better functional results, compared with the use of cold plasma ablation alone: reduction in the duration of discharge, acceleration of epithelialization, normalization of the colposcopic and cytologic picture, decrease in the frequency of relapses, a significant increase in the frequency of HPV elimination.

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

Cited by 8 publications

References 13 publications

ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer

ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer

Serous endometrial intraepithelial carcinoma: a case series and literature review

Analysis of the results of combined treatment of cervix precancerous pathology in reproductive aged women

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