Conization Using an Electrosurgical Knife for Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma
July
Conization Using an Electrosurgical Knife for Cervical Intraepithelial Neoplasia and Microinvasive Carcinoma
Libing Xiang 0 1 2
Jiajia Li 0 1 2
Wentao Yang 0 1 2
Xiaoli Xu 0 1 2
Xiaohua Wu 0 1 2
Huaying Wang 0 1 2
Ziting Li 0 1 2
Huijuan Yang 0 1 2
0 Funding: This study was supported by a grant from Shanghai Municipal Health Bureau (2007140, YHJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
1 Editor: Annie NY Cheung, The University of Hong Kong, Queen Mary Hospital , HONG KONG
2 1 Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University , Shanghai, 200032, China , 2 Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University , Shanghai, 200032 , China
The aim of the present study was to evaluate the incidences of margin involvement, disease relapse, and complications in patients who had undergone conization using an electrosurgical knife (EKC) for cervical intraepithelial neoplasia (CIN) or microinvasive carcinomas (micro-CAs).
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The median age of the patients was 39 years old (range: 19-72). Conization revealed the
presence of CIN in 1113 (81.9%) patients, micro-CA in 72 (5.3%) patients and invasive
carcinomas in 44 (3.2%) patients. The remaining 130 (9.6%) patients were free of diseases in
the cone specimens. Positive surgical margins, or endocervical curettages (ECCs) were
found in 90 (7.6%) patients with CINs or micro-CAs. Three factors were associated with
positive margins and ECCs and included age (>50 years; odds ratio (OR), 3.0, P<0.01),
postmenopausal status (OR, 3.1, P<0.01) and microinvasive disease (OR, 2.7, P<0.01).
One thousand and eighty-nine (92.0%) patients were followed-up regularly for a median
follow-up duration of 46 months (range: 24-106 months). Disease relapse was documented in
50 (4.6%) patients. Eighty-two (6.0%) cases experienced surgical complications that
needed to be addressed, including early or late hemorrhages, infections, cervical stenosis,
etc.
Our patients demonstrated that EKC was an alternative technique for diagnosis and
treatment of CIN or micro-CAs with relatively low rate of recurrence and acceptable rate of
complications. A randomized clinical trial is warranted to compare EKC, CKC and LEEP in the
management of CIN or micro-CA.
Cervical intraepithelial neoplasia (CIN) is a precancerous disease that precedes invasive
cervical carcinoma. The prevalences of CIN in the Chinese population are 3.1% for CIN1, 1.5% for
CIN 2 and 1.2% for CIN3[1]. Given the large population of China, the burden of this disease is
heavy. The early detection and appropriate management of CIN is an efficient strategy to
prevent preinvasive diseases from progressing to invasive diseases. Conization is a standard
surgical procedure for the treatment of high-grade CIN and is also a conservative treatment for
microinvasive carcinoma (FIGO stage 1A1, micro-CA) in patients who desire to maintain their
fertility. Currently, the loop electrosurgical excision procedure (LEEP) is more commonly used
in clinical practice in China than other techniques, such as cold-knife conization (CKC) or
laser conization. However, margin involvements are more frequently observed in LEEP than in
CKC conization and might lead to greater recurrence and further treatments[2–5].
In the Department of Gynecologic Oncology of Fudan University Shanghai Cancer Center in
Shanghai, China, conization using a electrosurgical knife (EKC) has been routinely used for the
treatment of high-grade CINs and micro-CAs since September 2003. The technique was shown
to be an easily accomplished technique that requires a simple setup and results in good
hemostasis in our short-term observation study[6, 7]. However, this surgical procedure has not been
well accepted due to margin carbonization and limited experience. In the present study, we
present our seven-year experience with EKC for CINs and micro-CAs and long-term follow-up
data.
This is a retrospective case series study of consecutive women who underwent EKC in the
Fudan University Shanghai Cancer Center (FUSCC) from September 2003 to July 2010. This
study was reviewed and approved by the Ethics Committee of FUSCC and was exempt from
written informed consent requirements (IRB 090876/6). The indications for conization were
pathologically proven high-grade CIN (HG-CIN), stage 1A1 microinvasive cervical carcinoma,
carcinoma in situ with suspected invasion, glandular dysplasia, residual HG-CIN after LEEP
and persistent low-grade CIN (LG-CIN).
The procedure of EKC was just like CKC, in which a cold knife was replaced by an traditional
monopolar electrosurgical knife. To reduce thermal damage to the specimens, attention was
given to avoiding prolonged contact between the knife blades and the specimens. The extents
of the excisions were adjusted (...truncated)