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

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.

The effectiveness of cold-knife conization (CKC) for post-menopausal women with cervical high-grade squamous intraepithelial lesion: a retrospective study

Background The effectiveness of surgery of high-grade squamous intraepithelial lesion in post-menopausal women needs to be investigated. This study evaluated the clinical significance of cold-knife conization in the diagnosis and surgery of cervical high-grade squamous intraepithelial lesions in post-menopausal women. Methods We conducted a retrospective analysis of post- and pre-menopausal patients with high-grade squamous intraepithelial lesion. All patients received cold-knife conization as the primary therapy. Results The satisfactory rate of colposcopy was significantly lower in the post-menopausal group than in the pre-menopausal group (38.33 vs. 71.25%; χ2 = 36.202, P < 0.001). The overall positive margin rate of cold-knife conization (25.83 vs 12.50%; χ2 = 10.106, P = 0.001) and rate of positive endocervical cone margins (16.67 vs. 4.58%; χ2 = 14.843, P < 0.001) were significantly higher in the post-menopausal group. Moreover, 49 post- and 60 pre-menopausal women underwent subsequent surgical treatment (40.83 vs. 25.00%). Residual rate of positive and negative margins in patients before and after menopause was significantly different (χ2 = 5.711, P = 0.017; χ2 = 12.726, P < 0.001, respectively). The recurrence rate in post-menopausal women remained 3.85%. Conclusions Cold-knife conization can be performed as a primary procedure for diagnosis and surgery of post-menopausal patients with high-grade squamous intraepithelial lesions. Sufficient deep excisions are necessary to avoid positive endocervical margins, which can reduce the residual and recurrence of postoperative lesions.

Necessity for subsequent surgery in women of child-bearing age with positive margins after cold knife conization: A retrospective cohort study

Background: Risk factors for positive margins and residual lesions after cold knife conization (CKC) for high-grade cervical intraepithelial neoplasias (CIN) were assessed in women of child-bearing age. A design for postoperative management and avoiding these situations is offered.Methods: This was a retrospective study on 1,309 premenopausal women with high-grade CIN (including CIN3 and CIN2) based on a cervical biopsy under colposcopy used to diagnose a positive or negative margin. Age, gravidity, parity, HPV species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and CIN grade were analyzed. Among those with positive margins, 245 underwent surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Residual lesions were also assessed.Results: There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P>0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P<0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P<0.02). Age >35 years was also a risk factor (P<0.03).Conclusion: High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially for women <35 years.

The effects of different instruments and suture methods of conization for cervical lesions

This study is to compare the surgical outcomes of patients undergoing cold knife conization (CKC) versus electrosurgical conization (ESC). Among 10,086 patients in a single center admitted between January 2000 and January 2019, CKS or ESC was used for grade 3 cervical intraepithelial neoplasia (CIN3) or more severe lesions. Modified Sturmdorf or Figure-of-eight sutures were applied after conization. A regression model was used to determine the risk factors for margin involvement and short-term post-operative complications. In total, 7275 (72.1%) and 2811 (27.9%) patients underwent CKC and ESC, respectively. Women who underwent ESC were older and had a higher risk of margin involvement and endocervical glandular involvement than those who underwent CKC in univariate analysis. However, in the multivariate analysis, age (odds ratio [OR] 1.032, 95% confidence interval [95% CI] 1.025–1.038) and glandular involvement (OR 2.196, 95% CI 1.915–2.517) were the independent risk factors associated with margin involvement, but the incision methods used caused no significant difference. Modified Sturmdorf sutures and Figure-of-eight sutures were applied in 3520 (34.9%) and 6566 (65.1%) patients, respectively. The modified Sturmdorf sutures was the only risk factor associated with wound hemorrhage (OR 1.852, 95% CI 1.111–3.085) after adjusted with other epidemiological and surgical factors. Various incision or suture methods had similar risk of cervical stenosis. Therefore, ESC is an acceptable alternative to CKC for the diagnosis and treatment of cervical lesions regarding the pathologic accuracy and integrity, and short-term safety. Modified Sturmdorf sutures increased the risk of wound hemorrhage compared with Figure-of-eight sutures.