A Randomized Prospective Study Comparing Three Techniques of Conization: Cold Knife, Laser, and LEEP

Mathevet, Patrice; Dargent, D; Roy, Michel; Beau, G

doi:10.1006/gyno.1994.1189

Cited by 180 publications

(124 citation statements)

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“…The adequacy of LEEP in the present study was not inferior to those of previous studies. We found that 64.5% of the patients with CIN were margin-free; such a frequency was in range with those of previous studies: 40-80% (Mathevet et al, 1994;Giacalone et al, 1999;Shin et al, 2009). We also found that the risk of the margin involved with the lesion was higher in CIN III than in CIN I-II; our finding was comparable with a previous report (Shin et al, 2009).…”

Section: Discussionsupporting

confidence: 87%

Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

Sangkarat

Ruengkhachorn²,

Benjapibal³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Discussionsupporting

confidence: 87%

Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

Sangkarat

Ruengkhachorn²,

Benjapibal³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…14,25,26 The literature presents many references to compromised margins, with percentages ranging from 0.0% to 30.5%, due to artifacts or fragmentation, thereby adversely affecting the histopathological interpretation. The highest rate (30.5%) was observed by Mathevet et al 27 in a study in which the equipment was not effective, and the physicians had various levels of experience with the procedure. Boardman et al 28 observed that 28% of their cases shown adverse effects on interpretation, with procedures conducted by physicians under training.…”

Section: Discussionmentioning

confidence: 89%

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

et al. 2012

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CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS:The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.reSUMO CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp

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“…According to the literature, it is estimated that up to 50% of the endocervical and ectocervical margins are compromised when the conventional LEEP technique is applied [13] . Thus, by using a clinically important difference of 30% between groups 1 and 2 in the percentage of compromised margins, a total of 45 patients for each group were considered.…”

Section: Population and Samplementioning

confidence: 99%

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

Rivoire

Monego

Reis

et al. 2009

Gynecol Obstet Invest

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The use of loop electrosurgical conization (LEC) for the treatment of large high-grade cervical intraepithelial neoplasias (CINs) is often associated with a difficult procedure that results in accidental sample fragmentation, thermal damage and sometimes the presence of positive margins. This study aims to compare LEC that removes the cervical cone in two blocks (anterior and posterior cervical lips – LEC2) with LEC performed with one pass of the loop (LEC1). In a randomized, controlled trial, patients that needed conization due to high-grade CIN were assigned to one of the techniques. There were no differences in terms of age, cone histopathological diagnosis, blood loss, vaginal injuries, stenosis of the cervical os and specimen artifacts. LEC2 required less hemostatic sutures. LEC2 showed no specimen fragmentation, while LEC1 did (0 vs. 5.9%; p = 0.10). As expected, LEC2 samples were heavier (p = 0.01), included a larger ectocervical area (p = 0.001) and, therefore, had a greater volume (p < 0.001) compared to LEC1 samples. The height of the LEC2 specimens was smaller than that of LEC1 specimens (p < 0.001). LEC2 yielded fewer cases of positive margins (12.7%) than LEC1 (33.3%; p = 0.021). We conclude that the LEC2 technique is an effective treatment choice: it is safe for the patient, with better outcomes regarding sample quality than LEC1. Further studies are encouraged regarding this procedure.

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A Randomized Prospective Study Comparing Three Techniques of Conization: Cold Knife, Laser, and LEEP

Cited by 180 publications

References 0 publications

Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia

Comparison of Loop Electrosurgical Conization with One or Two Passes in High-Grade Cervical Intraepithelial Neoplasias

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