Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol

Article Abstract:

Cervical intraepithelial neoplasia (CIN) is characterized by abnormal growths in the epithelial tissue of the cervix. When they are entirely visible, these lesions can be treated by lasers, which destroy them. However, follow-up examinations are necessary to ensure that there is no recurrence of CIN. Examination procedures include colposcopy, or the use of a magnifying lens to examine the cervix and obtain tissue for biopsy, and cytology, more commonly known as the Pap smear, in which cells are scraped from the cervix for laboratory examination. Some researchers contend that cytology alone is sufficient for follow-up while others argue that both techniques are needed. Finding the optimal follow-up procedure after laser treatment of CIN is important because colposcopy requires more resources than cytology. This study reviewed follow-up results of both cytology and colposcopy for 2,130 cases of CIN that were treated by laser vaporization; three-year follow-up was monitored for 1,253 patients and at least six years of follow-up was evaluated for 380 patients. A total of 119 (5.6 percent) treatment failures were found during follow-up. Treatment failures were much more likely for grade III CIN (75 percent) than for grade I CIN (7.6 percent). Detection of the failures occurred during the first year in 71 percent of cases, during the second year in 24 percent, and during the third year in 3.3 percent of the cases. In 21 patients (18 percent), treatment failure was found using colposcopy, while cytology results were negative. These results indicate that colposcopy should be used during the first year after laser treatment for CIN. Negative results after three years indicate that recurrence of disease is unlikely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pap test, Cervix diseases, Colposcopy

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A randomized trial comparing two methods of cold knife conization with laser conization

Article Abstract:

Two methods of conization (removal of a cone-shaped tissue specimen from the uterine cervix) are compared. The procedure is performed to diagnose or treat cervical intraepithelial neoplasia (CIN), cell changes that represent cancer or the stages that precede cancer. The methods that were used were the cold knife approach, which can result in hemorrhage or constriction (stenosis) of the cervix, and the carbon dioxide laser method. One hundred twenty-two women underwent the cold knife procedure; 62 had two sutures put in place, while the rest were not sutured. Sixty-one women had laser surgery. Results showed that early hemorrhage (within 24 hours of surgery) occurred more often in women who received no sutures than to women in the other two groups, but when hemorrhage frequency was evaluated for all three groups, there were no differences. Dysmenorrhea (painful menstruation) was more common in women who had larger cones removed (greater than 20 millimeters). Stenosis (to the point where the cervix would not allow a 3 millimeter cotton swab to be inserted) was as common after laser treatment as after cold knife treatment without sutures. Overall, cold knife conization without sutures was similar to laser conization in complication rate and the reliability of cervical smears in follow-up examinations; such smears may be unreliable if sutures have eliminated the cells to be evaluated. Furthermore, suturing leads to dysmenorrhea. Laser surgery can burn the tissue, making it impossible to determine if the edges of the cone are free from disease. This occurred in five of the cases reported. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Diagnosis, Complications and side effects, Surgery, Cervix uteri, Biopsy, Cervix uteri biopsy

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Laser vaporization versus laser excision conization in the treatment of cervical intraepithelial neoplasia

Article Abstract:

One hundred patients with cancer of the uterine cervix (cervical intraepithelial neoplasia) suitable for partial removal were treated either by laser vaporization (the conversion of a tumor to liquid) or by laser excision conization (removal of a cone of tissue in the partial removal of the uterine cervix). The effectiveness and complications of the two methods were comparable in most respects, and both were well accepted by the patients. Laser excision was preferred because it provided further material for examination.

Cervix dysplasia

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