A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)—a preliminary report

Abstract

Objective To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). Design A multicentre prospective cohort study. Setting CRC Clinical Trials Unit, Birmingham. Subjects 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. Intervention/Protocol Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. Main outcome measures Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. Results Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow‐up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. Conclusions Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Atypical Papanicolaou Smear in Pregnancy

“…Where no evidence of invasion exists, no further treatment is needed. 14,16,33,41 For patients with positive margins, no evidence exists that would indicate an advantage of repeat conization during pregnancy in an attempt to obtain clear margins. Negative margins, while promising in young women and if a 10 mm clear margin can be obtained, 42,43 are no assurance of freedom from disease.…”

Clinical Implication of a Typical Glandular Cells; a Five Years Experience of a Single Institution in Portugal

“…The literature shows that only 41% to 71% of AIS are diagnosed histologically through a cytological AGC report [15][16][17][18]. The neoplastic glandular cells can proliferate hidden under normal metaplastic and dysplastic squamous epithelium in 60% of the cases which makes these cells not accessible to cytological sampling [19].…”

Persistance et récidive des adénocarcinomes in situ après traitement : à propos d’une série rétrospective multicentrique de 121 cas

“…Dans notre série l'anse diathermique apparaît significativement associée à davantage de passage non in sano. Les données de la littérature vont aussi plutôt dans ce sens [15][16][17]. Toutefois, il nous faut préciser que si cette technique a été utilisée, c'est en très grande partie pour le traitement des lésions supposées exclusivement malpighiennes de haut grade, retrouvée dans 60 % de notre effectif, et ce n'est que fortuitement que l'AIS a été objectivé sur la pièce de conisation.…”

“…Il semble selon plusieurs études qu'en deçà de cette valeur, les berges soient plus fréquemment envahies. La hauteur du cône de résection apparaît donc comme un paramètre capital du traitement de l'AIS sans qu'il puisse pour autant expliquer à lui seul toutes les récidives constatées [14,17,[19][20][21]. Dans notre série, la hauteur moyenne du cône de résection est significativement plus élevée en cas de conisation in sano que dans le cas contraire (19,3 mm versus 13,5 mm, p < 0,001), mais reste très en deçà des recommandations.…”