Relationship between cervical excisional treatment for cervical intraepithelial neoplasia and obstetrical outcome

Monti, Marco; D’Aniello, Debora; Scopelliti, Annalisa; Tibaldi, Valentina; Santangelo, Giusi; Colagiovanni, Vanessa; Giannini, Andrea; Donato, Violante Di; Palaia, Innocenza; Perniola, Giorgia; Giancotti, Antonella; Muzii, Ludovico; Panici, Pierluigi Benedetti

doi:10.23736/s2724-606x.20.04678-x

Cited by 41 publications

(32 citation statements)

References 50 publications

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“…Last but not least, these studies recruited a wide range of patients, from CIN I to CIN III and even carcinoma in situ, which may increase the heterogeneity of the meta-analysis. A review showed that the surgical treatment of CIN was associated with an increased risk of obsterics [ 46 ], probably due to persistent HPV infection after surgery. Nevertheless, our study lays the foundation for further research in understanding the factors influencing persistent HPV infection after conization.…”

Section: Discussionmentioning

confidence: 99%

Persistent HPV infection after conization of cervical intraepithelial neoplasia—— a systematic review and meta-analysis

Zhang

Ni²,

Wei

et al. 2023

BMC Women's Health

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Objective To systematically evaluate several factors of persistent human papillomavirus (HPV) infection following conization in patients with cervical intraepithelial neoplasia (CIN). Methods PubMed, EMBASE and the Cochrane Library were searched from January 1, 1998 to September 10, 2021. Random-effects models for meta-analyses were used and pooled relative risks with 95% confidence intervals were reported. Literature screening, data extraction, and assessment of the risk of bias in the included studies were conducted independently by two researchers. Data analysis was performed with Stata software, version 12.0. Results A total of 28 studies were included in this study. Meta-analysis revealed that surgical margin and residual disease were positively correlated with persistent HPV infection after conization. Compared with patients infected with other types of HPV, CIN patients with HPV 16 had a higher persistent infection rate (OR = 1.967, 95% CI (1.232–3.140), P < 0.05). Conclusions CIN patients who are postmenopausal, have positive surgical margins and residual lesions, and are positive for HPV 16 are prone to persistent HPV infection after conization.

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Section: Discussionmentioning

confidence: 99%

Persistent HPV infection after conization of cervical intraepithelial neoplasia—— a systematic review and meta-analysis

Zhang

Ni²,

Wei

et al. 2023

BMC Women's Health

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“…Specifically, the height of the removed cone [ 5 ] and the presence of an HPV-related lesion alone, even without the execution of an excisional treatment [ 6 ], has been associated with a worsening of obstetric outcomes. In a systematic review of 32 studies, for example, Monti et al found a significantly elevated risk of premature delivery, low birth weight, and premature rupture of membranes in women with a history of surgery for cervical dysplasia [ 7 ]. This statistically and clinically significant increase in obstetrical risks is directly correlated with the number and extent of cervical procedures such as LEEP and LLETZ [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials

Hecken

Rezniczek

Tempfer

2022

Cancers

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Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have been made in the last decade. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled clinical trials reporting on the efficacy and safety of diagnostic and therapeutic interventions for cervical dysplasia. Data were analyzed according to PRISMA guidelines. In total, 33 studies reporting on 5935 women were identified. We recommend intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored 1 min after the application of acetic acid and should be followed by Lugol’s iodine test for an optimal yield of LSIL/HSIL. LEEP/LLETZ remains the standard and techniques such as SWETZ, C-LETZ, and TCBEE are not superior. LEEP/LLETZ should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with LSIL, especially in women with HIV infection, but LEEP/LLETZ remains the standard for HSIL. Topical imiquimod remains an experimental procedure. In conclusion, significant progress has been made in the last decade regarding both diagnostic interventions as well as therapeutic interventions for women with cervical dysplasia. Based on >30 controlled clinical trials, we were able to formulate specific and evidence-based recommendations.

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“…According to the 2019 American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines, women diagnosed with high-grade squamous intraepithelial lesions (HSIL) cervical intraepithelial neoplasia grade 2 (CIN2) and less than 25 years old or ≥ 25 years of age who wish to have children can be temporarily monitored, but if CIN2 persists for two years or progresses to cervical intraepithelial neoplasia grade 3 (CIN3), a cervical conization is required [ 2 ]. Cervical conization, comprising cold knife conization (CKC) and annular loopelectrical excision technique, was presently the standard surgery for the aforementioned indications [ 3 , 4 ]. To avoid missing early or latent cervical cancer, the objective of the therapy was to thoroughly eradicate the lesion and prevent its transformation into cancer.…”

Section: Introductionmentioning

confidence: 99%

The effect of cold-knife conization on pregnancy outcomes in patients with cervical lesions

Gao¹,

Wang²,

Xiao³

2022

PLoS ONE

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Objective To analyze the pregnancy outcomes of patients with cervical lesions treated by cold-knife conization (CKC). Methods Clinical data of healthy pregnant women and pregnant women who underwent CKC in Dalian Women and Children’s Medical Group from March 2010 to December 2019 were retrospectively analyzed. These patients were divided into a CKC group and a control group according to inclusion and exclusion criteria. Statistical methods were used to compare pregnancy and delivery outcomes between the two groups. Results There were 400 patients in CKC group and control group, with 200 patients in each. There was no significant difference in the mode of delivery, abortion, ectopic pregnancy, in-hospital perinatal management, and cervical cerclage between the CKC group and the control group (P>0.05). The rates of preterm delivery, premature rupture of membranes, cesarean section, and neonatal admission in the CKC group were higher than those in the control group (P<0.05). In the CKC group, the incidence of premature rupture of membranes within six months postoperatively was higher than that after six months (P<0.05). The incidences of preterm delivery and premature rupture of membranes were not completely consistent in different conization ranges (P<0.05). Conclusion CKC increases the incidence of preterm delivery, premature rupture of membranes, and neonatal adverse outcomes. Conization height can predict the occurrence of preterm delivery. Delaying pregnancy after surgery can reduce the incidence of adverse outcomes during the perinatal period.

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Relationship between cervical excisional treatment for cervical intraepithelial neoplasia and obstetrical outcome

Cited by 41 publications

References 50 publications

Persistent HPV infection after conization of cervical intraepithelial neoplasia—— a systematic review and meta-analysis

Persistent HPV infection after conization of cervical intraepithelial neoplasia—— a systematic review and meta-analysis

Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials

The effect of cold-knife conization on pregnancy outcomes in patients with cervical lesions

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