A 28-Year-Old P0 Woman with Adenocarcinoma In Situ Has Intraoperative Bleeding during a Cold-Knife Conization

2021 ◽  
pp. 70-73
Author(s):  
Seine Chiang
Keyword(s):  
Adenocarcinoma In Situ ◽  
Intraoperative Bleeding ◽  
Cold Knife ◽  
Cold Knife Conization

scholarly journals Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled non-inferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017576 ◽  
Author(s):  
Paul A Cohen ◽  
Alison Brand ◽  
Peter Sykes ◽  
David C H Wrede ◽  
Orla McNally ◽  
...  
Keyword(s):  
Scientific Journal ◽  
Cervical Screening ◽  
Excisional Biopsy ◽  
Adenocarcinoma In Situ ◽  
Invasive Adenocarcinoma ◽  
Cone Biopsy ◽  
Cold Knife ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

IntroductionAdenocarcinoma in situ (AIS) of the uterine cervix is the precursor to invasive endocervical adenocarcinoma. An excisional biopsy such as a cold knife cone biopsy (CKC) should be performed to exclude invasive adenocarcinoma. Loop electrosurgical excision procedure (LEEP) is an alternative modality to CKC but is controversial in AIS. There is a perception that there is a greater likelihood of incomplete excision of AIS with LEEP because the depth of excised tissue tends to be smaller and the tissue margins may show thermal artefact which can interfere with pathology assessment. In the USA, guidelines recommend that any treatment modality can be used to excise AIS, provided that the specimen remains intact with interpretable margins. However, there are no high-quality studies comparing LEEP with CKC and well-designed prospective studies are needed. If such a study were to show that LEEP was non-inferior to CKC for the outcomes of post-treatment persistence, recurrence and adenocarcinoma, LEEP could be recommended as an appropriate treatment option for AIS in selected patients. This would benefit women because, unlike CKC, LEEP does not require general anaesthesia and may be associated with reduced morbidity.Methods and analysisThe proposed exploratory study is a parallel group trial with an allocation ratio of 2:1 in favour of the intervention (LEEP: CKC). Participants are women aged ≥18 to ≤45 years diagnosed with AIS on cervical screening and/or colposcopically directed biopsy in Australia and New Zealand, who are to receive excisional treatment in a tertiary level centre.Ethics and disseminationEthical approval for the study has been granted by the St John of God Healthcare Human Research Ethics Committee (reference number #1137). Results from the study will be presented at conferences and published in a peer-reviewed scientific journal.RegistrationANZCTR registration number ACTRN12617000132347https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372173&isReview=true

scholarly journals Hystoroscopy Assisted Non-Suture Cold-Knife Conization and Cold-Knife Conization in Patients with CINIII: A Comparative Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Xiong J ◽  
◽  
Deng Y ◽  
Zhang H ◽  
◽  
...  
Keyword(s):  
Comparative Study ◽  
Postoperative Complication ◽  
Clearance Rate ◽  
Cure Rate ◽  
Intraoperative Bleeding ◽  
Hpv Clearance ◽  
Cold Knife ◽  
Cold Knife Conization ◽  
The Difference ◽  
Cervical Conization

167 patients of cervical conization were performed for CINIII in a 34-month study. Conization include Cold-Knife Conization (CKC) (n=120) and hystoroscopy assisted non-suture cold-knife conization (HCKC) (n=47). Both groups were similar in terms of age, indications for conization, and size of cervical cone specimens. Comparing with CKC group, HCKC group was done in a significantly shorter time (28.52±9.80 minutes vs. 52.19±18.09 minutes) (P<0.05), with less intraoperative bleeding of HCKC group (44.89±10.81 ml vs. 51.50±19.94 ml) (P<0.05), shorter hospitalization time (6.89±2.11 days vs. 7.63±1.40 days) (P<0.05, and higher HPV clearance rate (100% vs. 87.13%) (P<0.05) than CKC group. While, the difference in the cure rate (95% vs. 91%) (P>0.05) , the recurrence rate (0% vs. 1%) (P>0.05) and the postoperative complication (P>0.05) between HCKC group and CKC group were not significant. The margins of the excision were checked by rapid histologic examination, showing the incidence of residual CIN was lower in HCKC group (8.51%) than in CKC group (9.17%) (P>0.05). Our study indicates that HCKC is a better treatment than CKC in the management of patients with CINIII.

scholarly journals Analysis of Conization Results in Patients undergoing Hysterectomy for Uterine Adenocarcinoma

2020 ◽  
Vol 42 (05) ◽  
pp. 266-271
Author(s):  
Denise Gasparetti Drumond ◽  
Isabel Cristina Gonçalves Leite ◽  
Vivian de Oliveira Rodrigues ◽  
Gabriel Duque Pannain ◽  
Miralva Aurora Galvão Carvalho ◽  
...  
Keyword(s):  
Residual Disease ◽  
Common Knowledge ◽  
Epidemiological Data ◽  
Observational Research ◽  
Histopathological Analysis ◽  
Adenocarcinoma In Situ ◽  
Cold Knife ◽  
Multifocal Disease ◽  
Histopathological Result

Abstract Objective To observe if the histopathological result of a conization performed after cervical adenocarcinoma in situ diagnosis is compatible with the histopathological analysis of a subsequent hysterectomy. Methods The present descriptive and observational research consisted of the analysis of the medical records of 42 patients who were diagnosed with in situ adenocarcinoma postconization. The analysis consisted of whether there was compatibility between the histopathological reports of conization and hysterectomy and if there was an association between adenocarcinoma in situ and another neoplasia (squamous disease). Interpretation of any immunohistochemistry reports obtained was also performed. In addition, clinical and epidemiological data were also analyzed. Results A total of 42 conizations were performed, 33 (79%) were cold knife conizations and 9 (21%) were loop electrosurgical excision procedures (LEEPs). Of the patients analyzed, 5 (10%) chose not to undergo subsequent hysterectomy to preserve fertility or were < 25 years old. Out of the 37 patients with adenocarcinoma in situ who underwent subsequent hysterectomy, 6 (16%) presented with residual disease. This finding proved incompatible with the finding of the conizations, which had ruled out invasive cancer. Conclusion The prevalence of adenocarcinoma in situ increased in the past years. There is still a large part of the medical literature that advocates the use of conservative treatment for this disease, even though it is common knowledge that it is a multifocal disease. However, the majority of studies advocate that hysterectomy should remain the preferred treatment for women who have already completed their reproductive purpose.

scholarly journals Adenocarcinoma in situ of the Cervix – is Loop Electrosurgical Excision Procedure an Acceptable Alternative to Cold Knife Cone Biopsy?

2017 ◽  
Vol 13 (01) ◽  
pp. 24
Author(s):  
Mila Pontremoli Salcedo ◽  
Anthony Costales ◽  
Mark F Munsell ◽  
Preetha Ramalingam ◽  
Ricardo Dos Reis ◽  
...  
Keyword(s):  
Specimen Size ◽  
Margin Status ◽  
Adenocarcinoma In Situ ◽  
Median Length ◽  
Positive Margins ◽  
Specimen Volume ◽  
Cold Knife ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Objective: To compare cone specimen size between loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC), and evaluate the association between specimen size and margin status. Methods/materials: A retrospective review was performed of women with adenocarcinoma in situ (AIS) who underwent CKC or LEEP between 1998 and 2013. Specimen size, including length (distance from the external cervical os to the endocervical margin) and volume were compared between LEEP and CKC, and correlated with margin status. Results: Eighty-five patients underwent a total of 136 procedures, including 91 CKCs (67%) and 45 LEEPs (33%), with 27 removed as a single specimen (one-piece LEEP) and 18 as two specimens with an ectocervical specimen and a deeper endocervical top-hat specimen (two-piece LEEP). The two-piece LEEP specimen median length was significantly longer (2.1 cm) versus CKC (1.4 cm, p<0.01) and one-piece LEEP (0.6 cm, p<0.01). Median specimen volume was greater for two-piece LEEP (7.4 cm3) versus CKC (3.4 cm3, p<0.01) and one-piece LEEP (1.6 cm3, p<0.01). A higher rate of positive margins was noted when comparing all LEEP (67.6%) with CKC specimens (34.2%), p<0.01. However, when the LEEP specimens were analysed separately, one-piece LEEPs had a higher rate of positive margins (81.0%) versus CKC (34.2%) (p<0.01), but there were no significant differences between two-piece LEEP (50.0%) and CKC (34.2%), p=0.26. Conclusion: Our results suggest that a two-piece LEEP produces a larger specimen size with similar rates of positive margins compared with CKC. Given the decreased cost and morbidity compared with CKC, a two-piece LEEP should be considered in the management of women with AIS.

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