Minimally Invasive Therapy of Cervical Intraepithelial Neoplasia for Fertility Preservation

Milinović, Darko; Kalafatić, Držislav; Babić, Damir; Gršić, Helena Lovrić; Orešković, Slavko

doi:10.1007/s12253-009-9148-y

Cited by 9 publications

(7 citation statements)

References 20 publications

(32 reference statements)

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“…Heatley 9 in 280 consecutive loop specimens showed similar results and stated that almost 100% of CIN-involved crypts were within 4.8 mm of the epithelial surface. Milinovic et al 10 in 218 cone specimens also showed that the mean endocervical crypt involvement was 1.2 mm and that excision deeper than 4 mm removed >99% of CIN. In the same study, the authors also showed that in nulliparous and multiparous women, respectively, cone lengths of 15 and 18 mm did not result in any endocervical margin involvement.…”

Section: Discussionmentioning

confidence: 93%

Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome

Ang

Mukhopadhyay

Burnley³

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objective Recent meta-analyses have shown that loop treatment of the cervix of >10 mm depth may be associated with adverse outcomes in future pregnancies. The aim of this study is to assess the rate of incomplete excision and recurrent disease in relation to depth of excision in women of reproductive age undergoing loop treatment.Design Observational cohort study.Setting Colposcopy Clinic, Northern Gynaecological Oncology Centre, Gateshead, UK.Population In all, 1558 women undergoing loop treatment for high-grade cervical intraepithelial neoplasia (HGCIN) between 1998 and 2003.Methods Women were followed up until 2008. Recurrence was analysed using Kaplan-Meier plots.Outcome measures Incomplete excision rates and recurrence rates. Recurrence was defined as post-treatment disease with highgrade histology. Any dyskaryotic cytology on follow-up was also documented.Results Recurrent high-grade disease on histology was found in 57/1558 (3.7%) women. In women £35 years old, despite a greater rate of incomplete excision at the endocervical margin at loop depths <10 mm compared with ‡10 mm (24.4% versus 13.3%, P < 0.01), the recurrence rate was similar between the two groups (4.3% versus 3.4%, log-rank, P = 0.52). In contrast, a loop depth <10 mm was associated with a higher disease recurrence rate (7.5% versus 3.0%, log-rank, P = 0.05) in women >35 years. ConclusionIn women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for <10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies.

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Section: Discussionmentioning

confidence: 93%

Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome

Ang

Mukhopadhyay

Burnley³

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…Klieamnn and colleagues found that the mean depth of the cone specimens were 17.1mm and 22.4mm in patients with positive and negative surgical margins [22]. On the other hand, Papoutsis et al [23] calculated that the optimal cone depth to achieve clear surgical margins was 10 mm, while Milinovic and colleagues [24] found that cone depth of 15mm for nulliparous and 18mm for multiparous women were sufficient to achieve a negative endocervical margin. It is important to note, however, that the last two cited studies analyzed data from younger patients and did not include patients with carcinoma in situ, micro-invasive SCC or SCC lesions on the conization specimen histology.…”

Section: Discussionmentioning

confidence: 99%

Factors That Influence Surgical Margin State in Patients Undergoing Cold Knife Conization – A Single Center Experience

Алулоски

Tanturovski

Petruševska

et al. 2017

Prilozi

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“…We found several studies which analyzed optimal cone length to avoid positive cone margin, but most of them analyzed cone depth rather than cone length [ 15 16 ]. Milinovic et al [ 17 ] reported the appropriate length of conizaiton as 18 mm in multiparous and 15 mm in nulliparous patients to secure a negative margin status, and that was the only study which analyzed appropriate cone length for CIN. In this study, we referred to the appropriate cone cut-off value in women younger than 40 years and identified the appropriate cone length as 15 mm in single quadrant disease and 20 mm in 2 or more quadrant disease with 0.1 of probability of positive cone margin.…”

Section: Discussionmentioning

confidence: 99%

Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

et al. 2016

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ObjectiveTo identify key factors for predicting positive cone margin and appropriate cone length.MethodsWe retrospectively reviewed the margin status of patients who received conization with high grade cervical intraepithelial neoplasia, along with other factors such as patient age, parity, preoperative cytology, size of disease, type of transformation zone, and cone length from patient records. Cut-off value of cone length was analyzed in women younger than 40 years old because we design conization with minimum length especially for women who wish for future pregnancy. Cut-off value of cone length was defined as length corresponds to estimated probability of positive cone margin equal to 0.1 by logistic regression analysis with variables selected by stepwise methods.ResultsAmong 300 patients, 75 patients had positive cone margin. Multivariable analysis revealed that squamous cell carcinoma at preoperative cytology (p=0.001), 2 or more quadrant disease (p=0.011), and shorter cone length (p<0.001) were risk factors for positive cone margin. Stepwise methods identified cone length and size of lesion as important variables. With this condition, cut-off value of cone length was estimated as 15 mm in single quadrant disease and 20 mm in 2 or more quadrant disease, respectively.ConclusionWe identified the independent risk factors of positive cone margin and identified the cut-off value of cone length to avoid positive cone margin in women younger than 40 years old. Conization should be performed not only according to colposcopic findings including type of transformation zone but size of disease and cone length.

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Minimally Invasive Therapy of Cervical Intraepithelial Neoplasia for Fertility Preservation

Cited by 9 publications

References 20 publications

Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome

Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome

Factors That Influence Surgical Margin State in Patients Undergoing Cold Knife Conization – A Single Center Experience

Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

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