Outcomes of Laser Conization for Cervical Intraepithelial Neoplasia 2-3 and Microinvasive Cervical Cancer

Abstract

BackgroundCurrently, there is no standardized follow-up protocol for patients who undergo laser conization. Therefore, we retrospectively investigated the clinical outcomes of laser conization in patients with high-grade cervical intraepithelial neoplasia 2-3 (CIN 2-3) and microinvasive squamous cell carcinoma and assessed the risks of residual and recurrent lesions of the cervix uteri.MethodsThe medical and pathological records of 91 patients with CIN 2, 580 with CIN 3 and 73 with microinvasive cervical cancer (MIC) who underwent laser conization between January 2000 and December 2011 were retrospectively reviewed.ResultsPositive margins increased with the extent of disease and were observed in 5.5%, 8.9% and 16.4% patients with CIN 2, CIN 3 and MIC, respectively, while residual or recurrent disease was observed in 0%, 3.2% and 13.6% patients, respectively. Examination of specimens obtained through postconization biopsy or hysterectomy revealed that 1.5% and 20% patients with negative and positive margins, respectively, were diagnosed with residual or recurrent lesions. Among patients who were conservatively managed after conization, seven with CIN 3 exhibited residual or recurrent disease, as evidenced by abnormal cytological findings, within 2 years after conization.ConclusionsContinuous follow-up by cytology and colposcopy, particularly during the first 2 years after conization, can effectively detect early residual or recurrent disease in CIN 3 and MIC patients, regardless of their margin status.

Role of Close Endocervical Margin in Treatment Failure After Cervical Excision for Cervical Intraepithelial Neoplasia: A Retrospective Study

“…18 This was probably because all excisions were performed by the same experienced operator, a condition that is reported to be associated with lower rates of positive margins. 19 The global rate of positivity at follow-up (7.7%) was comparable with that found in previous studies for CO 2 laser excisions, which was 3.4% to 16.7% 1,[20][21][22][23] ; more specifically, our rate of positivity at follow-up in the case of positive margin was 20.5%, similar to that found by Arbyn et al 1 (14.1%; 95% CI, 3.0%-29.5%) 1 and the rate of positivity at follow-up in the case of close endocervical margin was slightly superior (8.3% versus 3.7%; 95% CI, 2.5%-5.1%), but still not significantly different from that of women with negative margins in our population (8.3% versus 7.0%, P ¼ .89). This small discrepancy must be interpreted with caution, because it could reflect the intrinsic characteristics of our population, independent from the histologic characterization of surgical margins.…”

Treatment Outcomes of Patients With Cervical Intraepithelial Neoplasia or Invasive Carcinoma Who Underwent Loop Electrosurgical Excision Procedure

“…This study demonstrated 87.8% of cure rate in primary resection which was in the range of 73% to 99% reported from previous studies [5][6][7][8]11]. On the other hand, our 12.2% failure rate was much lower than 26% reported by Serati et al which used CKC [5].…”

“…Various rates of cure or failure from each study may depend on many factors aside from the surgical procedure itself, e.g., personal features of the patients, practice of surgeon including the skill and aggressive surgical approach, duration of follow-up, timing to define failure, immediate outcomes of surgery including surgical margin, etc. [5][6][7][8].…”

“…Their higher failure rate may lie on their longer follow-up period of 2 years in defining persistence/recurrence. On the other hand, Kanayama et al found low rates of persistent/recurrent diseases after laser conization: only 3.2% for CIN 3 and 13.6% in MIC [ 6 ]. Their low failure rate may be due to a different technique (laser conization) as reflected by lower rates of positive margin than other studies: 8.9% in their study compared to 21.6% in Serati et al and 39.7% in our study.…”

“…LEEP has been proven to be equivalent to CKC in terms of the indications and treatment outcomes including complications and cure rate if performed properly [ 4 ]. Previous studies showed 73% to 99% cure rate of CIN by LEEP [ 5 , 6 ]. The wide range of cure rate or persistent or recurrent disease in each study could be influenced by various risk factors, such as, parity and age of patients, immune status especially human immunodeficiency virus (HIV) infection, status of resected margins, etc.…”