Carcinoma of the Cervix Following Conservative Management of Cervical Intraepithelial Neoplasia

Shumsky, A.G.; Stuart, Gavin; Nation, Jill

doi:10.1006/gyno.1994.1086

Cited by 25 publications

(12 citation statements)

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“…22 The incidence of invasive carcinoma after loop excision biopsy ranges from 0.2% to 0.4%. [23][24][25][26] In the present study, only one patient with positive ectocervical and endocervical margins with residual disease developed invasive carcinoma. The primary aim of patient follow up is to ensure adequate detection of residual or recurrent disease before progression to invasive carcinoma.…”

Section: Discussionmentioning

confidence: 88%

“…22 The development of invasive carcinoma following treatment by loop excision biopsy is considered a failure of treatment. [23][24][25][26] Shumsky et al found that inadequacy of excision and cytological follow up represent the most common causes of failure of treatment of loop excision biopsy. 25 In the guidance published in 1992, 27 the NHS Cervical Screening Programme recommended returning treated women with negative follow up smears to normal recall after five years.…”

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confidence: 99%

“…[23][24][25][26] Shumsky et al found that inadequacy of excision and cytological follow up represent the most common causes of failure of treatment of loop excision biopsy. 25 In the guidance published in 1992, 27 the NHS Cervical Screening Programme recommended returning treated women with negative follow up smears to normal recall after five years. The second edition 28 of the guidance (1997) acknowledged that some may not wish to return to annual screening until the 10th anniversary of treatment, especially for those with a history of high grade CIN, as was common practice before the 1992 guidelines were published.…”

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confidence: 99%

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Completeness of excision and follow up cytology in patients treated with loop excision biopsy

Zaitoun

McKee²,

Coppen³

et al. 2000

J Clin Pathol

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Aims-To assess the relation between the grade and the status of follow up cytology, the completeness of loop excision biopsies with cervical intraepithelial neoplasia (CIN), and the findings at follow up cytology, as well as the diVerences between complete and incomplete exclusion, using the odds ratio. Treatment failure was assessed. Methods-1600 women with CIN (290 CIN1, 304 CIN2, 1006 CIN3) were followed for a minimum of six months and a maximum of 10 years. A database was created and comparisons performed. The mean age of the patients was 37 years. Results-Excision was complete in over 84% of loops. Residual disease and recurrence of high grade dyskaryosis was more common in women with CIN 3 than CIN 2 or 1. No high grade dyskaryosis was seen in the fifth follow up smear in patients with CIN 1 and CIN 2. Residual, recurrent, and persistent disease was most common in patients with incompletely excised CIN at ectocervical and endocervical margins and deep margins of resection than in patients with completely excised CIN. The odds ratios were significantly higher in the women who had incomplete excision of CIN at ectocervical, endocervical, both ecto-and endocervical, and deep margins of resection compared with those with apparent complete excision of CIN lesions. One patient developed invasive squamous cell carcinoma 44 months after loop excision which showed CIN 3 invading endocervical crypts and extending to both ectocervical and endocervical margins of resection. Conclusions-At long term follow up, patients with CIN who have residual disease are at increased risk of persistent disease and should therefore be followed up regularly with cytology and colposcopy. The findings support national policy of returning women with treated CIN of any grade to normal recall after five years except for cases of CIN3 where excision was incomplete or equivocal. In these cases follow up with annual smear for 10 years is recommended. (J Clin Pathol 2000;53:191-196)

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Section: Discussionmentioning

confidence: 88%

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confidence: 99%

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confidence: 99%

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Completeness of excision and follow up cytology in patients treated with loop excision biopsy

Zaitoun

McKee²,

Coppen³

et al. 2000

J Clin Pathol

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“…In the management of CIN2+ the punch biopsy is primarily used to confirm the diagnosis of a high‐grade abnormality, thereby reducing the number of unnecessary treatments and the associated morbidity 9,10 . The punch biopsy also plays a role in the management of women undergoing ablative treatment for CIN because pretreatment biopsies are required to exclude invasive disease 11,12 …”

Section: Introductionmentioning

confidence: 99%

Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Underwood

Arbyn

Smith

et al. 2012

BJOG

103

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Background The colposcopy-directed punch biopsy is widely used in the management of women with abnormal cervical cytology; however, its accuracy compared with definitive histology from an excision biopsy is not well established.Objectives To assess the accuracy of the colposcopy-directed punch biopsy to diagnose high-grade cervical intraepithelial neoplasia (CIN) by performing a systematic review and meta-analysis.Search strategy A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed.Selection criteria Articles that compared the colposcopically directed cervical punch biopsy with definitive histology from an excisional cervical biopsy or hysterectomy.Data collection and analysis Random effects and hierarchical summary receiver operating characteristic regression models were used to compute the pooled sensitivity and specificity applying different test cut-offs for outcomes of high-grade CIN.Main results Thirty-two papers comprising 7873 paired punch/ definitive histology results were identified. The pooled sensitivity for a punch biopsy defined as test cut-off CIN1+ to diagnose CIN2+ disease was 91.3% (95% CI 85.3-94.9%) and the specificity was 24.6% (95% CI 16.0-35.9%). In most of the studies, the majority of enrolled women had positive punch biopsies. Pooling of the four studies where the excision biopsy was performed immediately after the punch biopsy, and where the rate of positive punch biopsies was considerably lower, yielded a sensitivity of 81.4% and specificity of 63.3%.Author's conclusion The observed high sensitivity of the punch biopsy derived from all studies is probably the result of verification bias.

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“…12,13 The punch biopsy also plays a role in the management of women undergoing ablative treatment for CIN because pre-treatment biopsies are required to exclude invasive disease. 14,15 Hence, there is an obvious need to subject women with clinically unhealthy cervix to a directed punch biopsy. Hence, this study was conducted to evaluate the histopathological diagnosis of a directed punch biopsy of cervix in women with unhealthy cervix and to study the age related incidence and the incidence of various precancerous and cancerous lesions of the cervix.…”

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Evaluation of histopathology of cervix in women with unhealthy cervix

Rajendiran

Gopalan

Ranganathan

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Carcinoma of cervix is the third most common cancer in women worldwide and most common female cancer in India. Most cervical cancers can be detected at pre-invasive state with an adequate screening and treated, preventing overt progression to invasive cancer and hence decreasing morbidity and mortality. This study was conducted to evaluate the histopathological diagnosis of cervix biopsy in unhealthy cervix and to determine the incidence of the various precancerous and cancerous lesions.Methods: It was a prospective study in the department of Obstetrics and Gynecology in a tertiary care hospital over a period of two years. 802 women with unhealthy cervix were included in the study. Punch biopsy was taken from the cervix and sent for histopathological examination.Results: Total of 802 women were included in the study. They were in the age group of 26-75years. 53.4% were in the age group of 40-49 years followed by 20% in the age group of 30-39 years. The most common finding was chronic cervicitis in 89.4% followed by CIN I in 4.1%, CIN II in 0.9% of patients, squamous cell carcinoma in 2.1% and endocervical carcinoma in 0.4%.Conclusions: Cancer cervix is an ideal malignancy for screening, can be detected early and the premalignant lesion can be treated to prevent the progress to invasive disease. Hence all women with unhealthy cervix should be subjected to punch biopsy to detect early cases of cancer & carcinoma in situ.

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Carcinoma of the Cervix Following Conservative Management of Cervical Intraepithelial Neoplasia

Cited by 25 publications

References 0 publications

Completeness of excision and follow up cytology in patients treated with loop excision biopsy

Completeness of excision and follow up cytology in patients treated with loop excision biopsy

Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Evaluation of histopathology of cervix in women with unhealthy cervix

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