Soğuk Koni̇zasyon Endi̇kasyonlarının ve Sonuçlarının Değerlendi̇ri̇lmesi̇

Abstract

Amaç: Bu çalışmanın amacı yüksek dereceli servikal lezyonların tedavisinde soğuk konizasyonunun etkinliğini ve endikasyonlarını belirlemektir. Materyal ve Metot: Bu çalışmaya 9 yıllık süreçte yüksek dereceli servikal lezyonu olan ve soğuk konizasyon ile tedavi edilen hastalar dahil edildi. Smear, kolposkopik biyopsi, soğuk konizasyon sonuçları ve mevcut total histerektomi spesimenleri arasında histopatolojik korelasyon yapıldı. Bulgular: Yüz otuz bir soğuk koni biyopsisi bu çalışma için analiz edildi. En sık görülen patoloji 64 (%48,9) ile CIN II-III idi. Diğer konizasyon sonuçları sıklık sırasına göre şöyledir; CIN I 29 (%22,1), Karsinom (Ca) 19 (%14,5) , servisit 14 (%10,7), negatif 5 (%3,8). Sonuç: Soğuk konizasyon, serviksin servikal intraepitelyal neoplazi (CIN) ve mikroinvaziv karsinomunun tedavisinde kabul edilebilir bir seçenek olmaya devam etmekte ayrıca tanısal ve terapötik etkinliği iyi bilinmektedir. Uygun şekilde yapıldığında, doğru bir histopatolojik tanı sağlar ve düşük komplikasyon riskine sahiptir; ayrıca çoğu vakada küratiftir. Elbette, mükemmel klinik sonuçlar yine de dikkatli, uzun süreli ve özenli bir takip gerektirmektedir.

Keywords

• Servikal intraepitelyal neoplazi
• servikal smear
• soğuk konizasyon

Evaluation of Cold Conization Indications and Results

Abstract

Objective: The aim of this study was to determine the efficiency and indications of cold knife conization in the treatment of high-grade cervical lesions. Materials and Methods: This study included patients with high-grade cervical lesions treated with cold knife conization (CKC) within 9 years. Histopathological correlation analyses were carried out among the smear, colposcopic biopsy (CBx), CKC results, and total hysterectomy specimens available. Results: One hundred thirty-one cold knife cone biopsy cases were analyzed for this study. The most common pathology was cervical intraepithelial neoplasia (CIN) II–III, with a frequency of 64 (48.9%). Other conization results in order of frequency were as follows: CIN I at a rate of 29 (22.1%), Carcinoma (Ca) at 19 (14.5%), cervicitis at 14 (10.7%), and negative results at 5 (3.8%). Conclusions: CKC remains an acceptable option in the treatment of CIN and microinvasive carcinoma of the cervix, and the excellent diagnostic and therapeutic efficacy of CKC is well-known and confirmed. When properly performed, the procedure has a low risk of complications and provides an accurate histological representation of the disease process. It is also curative in most cases. Of course, excellent clinical results still require careful, long-term, and attentive follow-up.

Keywords

• Cervical intraepithelial neoplasia
• cervical smear
• cold knife conization

References

1. Farzaneh F, Faghih N, Hosseini MS, Arab M, Ashrafganjoei T, Bahman A. Evaluation of neutrophil-lymphocyte ratio as a prognostic factor in cervical intraepithelial neoplasia recurrence. Asian Pac J Cancer Prev. 2019;20(8):2365-2372. doi:10.31557/APJCP.2019.20.8.2365
2. Santesso N, Mustafa RA, Wiercioch W, et al. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. Int J Gynaecol Obstet. 2016;132(3):266-271. doi:10.1016/j.ijgo.2015.07.026
3. Van de Vijver A, Poppe W, Verguts J, Arbyn M. Pregnancy outcome after cervical conisation: a retrospective cohort study in the Leuven University Hospital. BJOG. 2010;117(3):268-273. doi:10.1111/j.1471-0528.2009
4. Gao Y, Wang H, Xiao Y. The effect of cold knife conization on pregnancy outcomes in patients with cervical lesions. PLoS One. 2022;17(12):e0278505. doi:10.1371/journal.pone.0278505
5. Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2013;13(12):CD001318. doi:10.1002/14651858
6. Obut M, İskender CT, Kından A, et al. Factors affecting obstetric outcomes in patients who underwent cold-knife and loop electrosurgical excision procedure conization due to CIN 2 or CIN 3. J Turk Ger Gynecol Assoc. 2023. doi:10.4274/jtgga.galenos.2023-1-15
7. Ma X, Yang M. The correlation between high-risk HPV infection and precancerous lesions and cervical cancer. Am J Transl Res. 2021;13(9):10830-10836.
8. Pourroostaei Ardakani P, Abkhiz S, Sheykhi K, et al. Molecular investigation of the association among common interleukin-6 polymorphism and human papillomavirus genotypes with cervical cancer among Iranian women. Monoclon Antib Immunodiagn Immunother. 2023;42(4):125-131. doi:10.1089/mab.2022.0039

9. Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Pract Res Clin Obstet Gynaecol. 2020;65:98-108. doi:10.1016/j.bpobgyn.2020.02.008
10. Kurmyshkina OV, Dobrynin PV, Kovchur PI, Volkova TO. Sequencing-based transcriptome analysis reveals diversification of immune response- and angiogenesis-related expression patterns of early-stage cervical carcinoma as compared with high-grade CIN. Front Immunol. 2023;14:1215607. doi:10.3389/fimmu.2023.1215607
11. Ruan Y, Liu M, Guo J, Zhao J, Niu S, Li F. Evaluation of the accuracy of colposcopy in detecting high-grade squamous intraepithelial lesion and cervical cancer. Arch Gynecol Obstet. 2020;302(6):1529-1538. doi:10.1007/s00404-020-05740-x
12. Papoutsis D, Underwood M, Parry-Smith W, Tzavara C. Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024;309(3):939-948. doi:10.1007/s00404-023-07242-y
13. Cai L, Huang Y, Lin C, et al. A comparison study of post-operative infection analysis of cold knife conization and loop electrosurgical excision procedure for cervical high-grade squamous intraepithelial lesion. Transl Cancer Res. 2020;9(2):949-957. doi:10.21037/tcr.2019.12.34
14. A J, Lei H, Xie X, Sun P. An abnormal precone endocervical curettage result is an independent risk factor for positive margins in conization specimens. Oncol Res Treat. 2020;43(10):518-525. doi:10.1159/000509254
15. Zeng Y, Jiang T, Zheng Y, et al. Risk factors predicting residual lesion in subsequent hysterectomy following cold knife conization (CKC) for high-grade squamous intraepithelial lesion (HSIL). BMC Womens Health. 2022;22(1):358. doi:10.1186/s12905-022-01939-z
16. Mohamed-Noor K, Quinn MA, Tan J. Outcomes after cervical cold knife conization with complete and incomplete excision of abnormal epithelium: a review of 699 cases. Gynecol Oncol. 1997;67(1):34-8. doi:10.1006/gyno.1997
17. Reich O, Lahousen M, Pickel H, Tamussino K, Winter R. Cervical intraepithelial neoplasia III: long-term follow-up after cold-knife conization with involved margins. Obstet Gynecol. 2002;99(2):193-6. doi:10.1016/s0029-7844(01)01683-0
18. Purut YE, Giray B, Akis S, et al. Effect of Human Papillomavirus Subtype on the Rate of Positive Surgical Margin After Cervical Conization. Int J Surg Pathol. 2023;31(1):20-25. doi:10.1177/10668969221143460
19. Kim YT, Kim JW, Kim DK, Song CH. Loop diathermy and cold knife conization in patients with cervical intraepithelial neoplasia: a comparative study. J Korean Med Sci. 1995;10(4):281-6. doi:10.3346/jkms.1995.10.4.281
20. Cooper DB, Carugno J, Dunton CJ, Menefee GW. Cold knife conization of the cervix. 2023 Oct 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
21. Jiang Y, Chen C, Li L. Comparison of cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ (ACIS): A systematic review and meta-analysis. PLoS One. 2017;12(1):e0170587. doi:10.1371/journal.pone.0170587
22. Baiocchi G, Diniz TP, Bovolim G, et al. Predictive factors for residual disease after conization in cervical cancer. Ann Surg Oncol. 2021;28(11):6673-6681. doi:10.1245/s10434-021-09656-x
23. Cohen PA, Leung Y, Anderson L, et al. Excisional treatment comparison for in situ endocervical adenocarcinoma (EXCISE): A phase 2 pilot randomized controlled trial to compare histopathological margin status, specimen size and fragmentation after loop electrosurgical excision procedure and cold knife cone biopsy. Gynecol Oncol. 2020;159(3):623-629. doi:10.1016/j.ygyno.2020.09
24. Ikeda M, Mikami M, Yasaka M, et al. Association of menopause, aging and treatment procedures with positive margins after therapeutic cervical conization for CIN 3: a retrospective study of 8,856 patients by the Japan Society of Obstetrics and Gynecology. J Gynecol Oncol. 2021;32(5):e68. doi:10.3802/jgo.2021.32.e68
25. Mosseri J, Hocquemiller R, Mergui JL, Uzan C, Canlorbe G. Laser conization for cervical intraepithelial neoplasia: Effectiveness and obstetric outcomes. J Gynecol Obstet Hum Reprod. 2022;51(4):102341. doi:10.1016/j.jogoh.2022.102341
26. Bogani G, DI Donato V, Sopracordevole F, et al. Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser conization: A 5-year follow-up study. Gynecol Oncol. 2020;159(3):636-641. doi:10.1016/j.ygyno.2020.08.025
27. Bueno LR, Binda M, Monego H, et al. Randomized clinical trial comparing cold knife conization of the cervix with and without lateral hemostatic sutures. Int J Surg. 2015; 18:224-9. doi:10.1016/j.ijsu.2015.04.081
28. Wang X, Li L, Bi Y, Wu H, Wu M, Lang J. The effects of different instruments and suture methods of conization for cervical lesions. Sci Rep. 2019 13;9(1):19114. doi:10.1038/s41598-019-55786-4
29. Song T, Seong SJ, Kim BG. Regeneration process after cervical conization for cervical intraepithelial neoplasia. Obstet Gynecol. 2016;128(6):1258-1264. doi:10.1097/AOG.0000000000001755
30. Zebitay AG, Güngör ES, Ilhan G, et al. Cervical conization and the risk of preterm birth: A population-based multicentric trial of Turkish cohort. J Clin Diagn Res. 2017;11(3):QC21-QC24. doi:10.7860/JCDR/2017/22996.9495