Laser conization: Follow-up in patients with cervical intraepithelial neoplasia in the cone margin

The Immediate Postconization Endocervical Smear

“…In fact, those with positive margins in the excised tissue specimen may not have residual dysplastic cells in the remaining cervix and/or endocervix soon after the procedure, presumably due to the subsequent tissue response (destruction, inflammation and repair). 1,8,9,14 Such a concept is supported in this study by the failure to detect dysplasia in all four patients with positive endocervical conization margins in whom followup cytology was available.…”

“…Even in the presence of involved surgical margins, many choose to follow patients with colposcopy and cervical/endocervical smears at three-to six-month intervals rather than perform additional surgical procedures; previous studies appear to support such a practice. 1,8,9,14 Many studies have shown that while a positive endocervical margin seems to indicate a higher risk of residual dysplasia, there is no significant difference between those with involved, as compared to uninvolved, margins with regard to long-term follow-up. In fact, those with positive margins in the excised tissue specimen may not have residual dysplastic cells in the remaining cervix and/or endocervix soon after the procedure, presumably due to the subsequent tissue response (destruction, inflammation and repair).…”

“…Although some studies 7,15,17 have shown that margin involvement at conization reflects true residual disease, others have suggested that involvement of either margin may not truly reflect significant residual disease or adversely affect patient outcome. 1,8,9,14 In spite of this, most gynecologists continue to request this information as a potentially important factor in the decision to proceed with further surgical therapy or simply observe. As an adjunct to the histologic evaluation of surgical margins in excised tissue, some gynecologists also obtain an immediate postprocedure endocervical sample (either endocervical curettage or endocervical smear) in an attempt to identify residual dysplasia in the endocervical canal.…”

Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment

“…Histological examination may suggest incomplete excision of cervical intraepithelial neoplasia (CIN) after both knife conisation (Buxton et al 1987) and laser conisation (Andersen et al 1990). The consensus view for both these methods of treatment is that, while residual disease is found more frequently after incomplete rather than complete histological excision, it is justified to adopt an expectant approach to follow‐up.…”

Evaluation of Two Commercially Available DNA Tests for Detection of Human Papillomavirus

“…[1][2][3] More recently, molecular, clinicopathologic, viral, and DNA studies have continued to demonstrate similarities between condyloma and cervical intraepithelial neoplasia (CIN) I and between CIN II and CIN III. 4 These similarities are reflected in the Bethesda System for reporting Papanicolaou-stained smears which divides the spectrum of morphologic squamous changes into lowgrade squamous intraepithelial lesion (SIL) (condyloma, CIN I) and high-grade SIL (CIN II,…”