TY - JOUR
T1 - Laser conization assisted by crypt visualization for cervical intraepithelial neoplasia
AU - Bandieramonte, Gaetano
AU - Lomonico, Sebastiano
AU - Quattrone, Pasquale
AU - Stefanon, Bernardina
AU - Merola, Marina
AU - Bucci, Alessandra
PY - 1998/2
Y1 - 1998/2
N2 - Objective: To describe intraoperative visualization of crypts and its effects on specimen clearance, safety, and clinical results of excisional treatment of cervical intraepithelial neoplasia (CIN). Methods: We treated 147 patients with high-grade CIN (II-III) and colposcopically-assessed endocervical extension, using a CO2 laser instrument in a day-hospital setting. Endocervical walls were stained preoperatively with a 2% methylene blue aqueous solution. Cervical conization was done by laser under colposcopic vision. Stromal incision and cone shape were directed laterally to the endocervical crypts by intraoperative visualization in transparency of the stain. Results: We were able to make stromal incisions at minimal and uniform radial distances from the cervical canal, thus allowing individualized cone shape and optimal bleeding control. Median (range) base diameter and height of specimens were 18 (13-24) and 20 (15-26) mm, respectively. The final histologic diagnosis was CIN II in 35 patients, CIN III in 111, and microinvasive carcinoma in one. Endocervical disease extension was confirmed in 103 patients (70%) the median (range) length of CIN in the 99 evaluable cases was 15.6 (0.5-25.7) mm, and crypt involvement was found in 39 (26.5%). All lateral margins were free of dysplasia. Four specimens (2.7%) had positive apical margins. No significant complications occurred, and fertility did not seem to be impaired. With a median (range) follow-up period of 68 (60-92) months, only 1.4% of patients experienced recurrence; two patients, both with involved crypts, had recurrent dysplasia at 23 and 45 months, respectively. Conclusion: Laser microsurgical conization assisted by crypt visualization facilitates safe and complete removal of CIN extending into the endocervix.
AB - Objective: To describe intraoperative visualization of crypts and its effects on specimen clearance, safety, and clinical results of excisional treatment of cervical intraepithelial neoplasia (CIN). Methods: We treated 147 patients with high-grade CIN (II-III) and colposcopically-assessed endocervical extension, using a CO2 laser instrument in a day-hospital setting. Endocervical walls were stained preoperatively with a 2% methylene blue aqueous solution. Cervical conization was done by laser under colposcopic vision. Stromal incision and cone shape were directed laterally to the endocervical crypts by intraoperative visualization in transparency of the stain. Results: We were able to make stromal incisions at minimal and uniform radial distances from the cervical canal, thus allowing individualized cone shape and optimal bleeding control. Median (range) base diameter and height of specimens were 18 (13-24) and 20 (15-26) mm, respectively. The final histologic diagnosis was CIN II in 35 patients, CIN III in 111, and microinvasive carcinoma in one. Endocervical disease extension was confirmed in 103 patients (70%) the median (range) length of CIN in the 99 evaluable cases was 15.6 (0.5-25.7) mm, and crypt involvement was found in 39 (26.5%). All lateral margins were free of dysplasia. Four specimens (2.7%) had positive apical margins. No significant complications occurred, and fertility did not seem to be impaired. With a median (range) follow-up period of 68 (60-92) months, only 1.4% of patients experienced recurrence; two patients, both with involved crypts, had recurrent dysplasia at 23 and 45 months, respectively. Conclusion: Laser microsurgical conization assisted by crypt visualization facilitates safe and complete removal of CIN extending into the endocervix.
UR - http://www.scopus.com/inward/record.url?scp=0032005045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032005045&partnerID=8YFLogxK
U2 - 10.1016/S0029-7844(97)00663-7
DO - 10.1016/S0029-7844(97)00663-7
M3 - Article
C2 - 9469287
AN - SCOPUS:0032005045
VL - 91
SP - 263
EP - 269
JO - Obstetrics and Gynecology
JF - Obstetrics and Gynecology
SN - 0029-7844
IS - 2
ER -