Long-term follow-up of cervical intraepithelial neoplasia treated with minimal conization by carbon dioxide laser

Békássy, Zoltán

doi:10.1002/(sici)1096-9101(1997)20:4<461::aid-lsm13>3.0.co;2-e

Cited by 12 publications

(4 citation statements)

References 13 publications

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“…These exclusions are described individually in the results. The authors of several articles generously made original data available 3,4 or sent the original protocol and data collection forms 5 to assist in this analysis. We were unable to make contact with some others.…”

Section: Methodsmentioning

confidence: 99%

“…In some of these, the authors kindly provided further information. 3,5 The article by Bekassy 3 was excluded because the ''women years at risk'' in any period in this study seemed to have been determined by the number of smear results reported in that period rather than the number of women under observation. A second study 6 was excluded because it proved impossible to determine recurrence rates in different intervals in spite of initial appearances to the contrary.…”

Section: The Search and Exclusionsmentioning

confidence: 99%

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Long‐term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia

Soutter

Sasieni

Panoskaltsis

2005

Intl Journal of Cancer

203

133

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Invasive cancer of the cervix after treatment for cervical intraepithelial neoplasia (CIN) is becoming more important, as screening reduces the incidence of invasive disease. The rate of invasive cervical or vaginal cancer following treatment for CIN in UK remains elevated for at least 8 years. The aim of our study was to determine from international data how long this rate remains elevated and whether the rate of invasive disease reflects the rate of posttreatment CIN. The aim was to determine why the rate of invasive disease does not fall. A search of Medline and a secondary search of cited references identified 1,848 articles referring to the success rate of the treatment of CIN. Only 26 cohorts from 25 articles met all the inclusion criteria. The policy in these was to perform at least annual smears. After the first year following treatment for CIN, the rate of invasive disease remained about 56 per 100,000 woman years until at least 20 years after treatment. This rate is~2.8 times greater than expected. In contrast, the risk of posttreatment CIN declined steadily with time to about 190 per 100,000 women in the 10th year. Although the posttreatment rate of CIN falls with time, the rate of invasive disease remains static. It seems likely that this is due to diminishing compliance with follow-up. Women should be encouraged to persevere with annual smears for at least 10 years after their treatment as this may offer them the best chance of detecting recurrence at a treatable stage. ' 2005 Wiley-Liss, Inc.Key words: cervical neoplasms; cervical intraepithelial neoplasia; treatment; follow-up; patient compliance Invasive cancer of the cervix occurring after treatment for cervical intraepithelial neoplasia (CIN) is becoming more important, as screening reduces the overall incidence of invasive disease. In 1997, a multicentre UK study of 44,699 women years of followup after conservative treatment of CIN showed that the cumulative rate of invasion after 8 years was 5.8 per 1,000 women and that the rate remained the same throughout the 8-year period such that these women remained at~5 times greater risk than the general population.1 The second edition of the NHS Cervical Screening Programme Guidelines, 2 published in the same year, described the controversy surrounding the optimum duration of annual cytology testing after the treatment of CIN. It also referred to the importance of confirming that the rate of invasive disease did not fall and of investigating the reasons for this continuing high risk.The present study was commissioned by NHS Cervical Screening Programme to undertake an analysis of long-term follow-up studies of women treated for CIN. The first objective was to determine from international data how long the rate of invasive cervical or vaginal cancer following treatment for CIN remains elevated. The second objective was to establish whether the rate of invasive disease was a reflection of the rate of posttreatment CIN. The aim was to investigate the reasons for the continuing high risk of invasive dis...

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Section: Methodsmentioning

confidence: 99%

Section: The Search and Exclusionsmentioning

confidence: 99%

Long‐term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia

Soutter

Sasieni

Panoskaltsis

2005

Intl Journal of Cancer

203

133

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“…This may be due to many studies not providing separate estimates of persistent disease vs. recurrent disease; even where this is done, there is no universal definition of the time frame for separating persistent from recurrent disease. For example, Bekassy found the cumulative risk of recurrent CIN after carbon dioxide laser for CIN 1–3 to be 0.89% at year 5, 1.36% at year 10, and 3.02% at year 15, after a primary success rate of 96.1% (13) . By contrast, Mitchell et al in a recent randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision of CIN 1–3 reported recurrent disease after only 6–37 months follow‐up in 19%, 13%, and 13% of subjects, respectively, (14) .…”

Section: Discussionmentioning

confidence: 99%

Influences on the risk of recurrent high grade cervical abnormality

Mitchell

Hocking

2002

Int J Gynecol Cancer

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The objective of this study is to determine the risk of recurrent abnormality after a first episode of high-grade epithelial abnormality and its evolution over time in a population setting. Two cohorts were established from a statewide registry. The cervical intraepithelial neoplasia (CIN) cohort comprised 6849 women with a biopsy of CIN 2, 2/3 or 3 (squamous or glandular) during 1990-92. A cohort of 6857 women with negative cytology during 1990-92 was used for comparison. The CIN cohort had a significantly greater rate of subsequent high-grade epithelial abnormality than the negative cohort. The risk increased with age. For women over 50 years at the incident biopsy, the rate ratio for subsequent high-grade epithelial abnormality was 24.45 (95% CI, 7.2, 84.3). The rate of subsequent high-grade epithelial abnormality was greater if the incident biopsy was CIN 3 (rate 13.50 per 1000 person years [95% CI, 12.5, 14.6]) rather than CIN 2 or 2/3 (rate 7.83 per 1000 person years [95% CI, 7.1, 8.7]). The rate ratio for subsequent invasive cancer was 9.46 (95% CI, 2.5, 35.3) when the CIN cohort was compared with the negative cohort. We conclude the risk of recurrent high-grade epithelial abnormality is related to the age and degree of abnormality on the incident biopsy. Screening policies should acknowledge the risk does not diminish with time.

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“…Therefore, a followup of the patients treated surgically is mandatory and the use of HPV-PCR is more sensitive than cytology alone for identifying response [Chua and Hjerpe, 1997]. The complete destruction of malignant tissue by laser must be replaced by surgical excision (laser, loop electrosurgical excision procedure, cold knife), allowing ad-equate histo-pathological examination of all excised tissue including the entire transformation zone and 5 mm of the endocervical canal [Béká ssy, 1997].…”

Section: Discussionmentioning

confidence: 99%

Cidofovir, a new approach for the treatment of cervix intraepithelial neoplasia grade III (CIN III)

et al. 2000

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Cervix intraepithelial neoplasia grade III (CIN III) is an intraepithelial proliferative process with different levels of severity depending on both the extension of the proliferation in the epithelium and the presence of cellular atypia. Human papillomavirus (HPV) has been clearly associated with such lesions. The results of a preliminary study are described on the local application of cidofovir, an acyclic nucleoside phosphonate derivative with broad-spectrum anti-DNA virus activity for the treatment of CIN III. Cidofovir 1% in gel was applied three times, every other day, on the cervix of each of 15 women with biopsy proven CIN III. Within 1 month after the start of treatment, the cervix was removed surgically. Histology and human papillomavirus polymerase chain reaction (HPV-PCR) were carried out. In 7 of the 15 patients the histology showed a complete response, whereas 5 patients had a partial response characterized by the persistence of CIN II-III lesions, 1 patient had a dysplasia of lower grade (CIN I), and 2 patients did not show differences in the histology. Complete response was confirmed by PCR in 4 of the 7 patients, with complete response histologically. Cidofovir was not toxic to the normal epithelium. Cidofovir 1% gel was able to inhibit partially or completely cervical dysplasia lesions after only three applications (every other day). This effect was specific and tissue other than the dysplastic epithelium was not affected by the treatment.

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Long-term follow-up of cervical intraepithelial neoplasia treated with minimal conization by carbon dioxide laser

Cited by 12 publications

References 13 publications

Long‐term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia

Long‐term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia

Influences on the risk of recurrent high grade cervical abnormality

Cidofovir, a new approach for the treatment of cervix intraepithelial neoplasia grade III (CIN III)

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