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  1 / 814 MEDLINE  
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PMID:29179270
Autor:Liu L; Chen LM; Tao X; Dai F; Guo LP; Zhang HW; Zhou XR; Sui L
Endereço:Cervical Disease Diagnosis and Treatment Center, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.
Título:[Clinical outcome and high risk factor for residual lesion analysis of HSIL half a year after loop electrosurgical excision procedure: a clinical study of 1 502 cases].
Fonte:Zhonghua Fu Chan Ke Za Zhi; 52(11):751-756, 2017 Nov 25.
ISSN:0529-567X
País de publicação:China
Idioma:chi
Resumo:To analyze clinical outcome of high-grade squamous intraepithelial lesion (HSIL) half a year after loop electrosurgical excision procedure (LEEP) and explore the high risk factor of residual cervical HSIL. The retrospective study was carried out on 1 502 patients who underwent LEEP, with HSIL in the LEEP histopathology from January 2011 to December 2013 at Obstetrics and Gynecology Hospital of Fudan University to confer the difference between residual group and non-residual group after 6 months of the leep conization. Patients were followed with ThinPrep cytologic test (TCT), high risk HPV (HR-HPV) test, colposcopy guided biopsy (CBD) and endocervical curettage (ECC). The high risks of residual cervical HSIL was analyzed. Among 1 502 cases, 48 (3.20%, 48/1 502) cases suffered HSIL residual disease. Forty cases were diagnosed by CBD, 4 cases were diagnosed by ECC. The other 4 cases were both positive in CBD and ECC. Residul rate were different among different age groups. The residual rate was higher in the age ≥50 years old compared to the age below 50 [9.70% (16/165), 2.39% (32/1 337); χ(2)=25.33, 0.01]. For post-LEEP specimens, both circumference (2.5, 2.8 cm; 3.17, 0.01) and width [0.6, 0.6 cm; 2.88, 0.01) were less in HSIL lesion residual group than those in non-residual group, though length showed no obvious difference [1.5, 1.5 cm; 1.55, 0.05) . The residual rate of leep positive margin was obviously higher than that in the negative margin group [6.77% (18/266) vs 2.43% (30/1 236) ; χ(2)=13.30, 0.01]. Different positive margin had diverse residual rate, as positive endocervical margin was 16.07% (9/56), positive margin undetermined was 7.29%(7/96) and positive ectocervical margin was 3.33%(4/120). Both positive endocervical margin and positive margin undetermined had a higher residual rate than residual rate (χ(2)=26.99, 0.01; χ(2)=4.24, 0.05). Abnormal cytology showed higher residual rate than the non-residual with significant difference [6.00% (6/100) vs 1.29% (14/1 083) , χ(2)=9.50, 0.01]. In terms of the post-LEEP HR-HPV test follow-up, HR-HPV positive's residual rate was higher than that in the negative group [2.91% (6/206) vs 0.96% (7/727)], while there was no statistical significance (χ(2)=3.10, 0.05). Multivariate logistic analysis showed that abnormal cytology in 6 month's follow-up post-LEEP conization was an independent risk factor on residual lesion ( 3.75, 0.05). Patient with age ≥50 years old and positive endocervical margin are high risk factors for the residual HSIL lesion after LEEP conization,especially for abnormal cytology during follow up is independent risk factor for residual lesion. Colposcopy directed biopsy and (or) ECC still play an indispendsable role in finding the HSIL residual lesion.
Tipo de publicação: JOURNAL ARTICLE


  2 / 814 MEDLINE  
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PMID:28691333
Autor:Castle PE; Murokora D; Perez C; Alvarez M; Quek SC; Campbell C
Endereço:Albert Einstein College of Medicine, Bronx, NY, USA.
Título:Treatment of cervical intraepithelial lesions.
Fonte:Int J Gynaecol Obstet; 138 Suppl 1:20-25, 2017 Jul.
ISSN:1879-3479
País de publicação:United States
Idioma:eng
Resumo:Precancerous cervical lesions precede the development of invasive cervical cancer by 10-20 years, making cervical cancer preventable if these lesions are detected and effectively treated. Treatment has evolved in the last few decades and now includes ablative options that can be performed in lower-resource settings where surgical excision is not feasible or routinely available. Gas-based cryotherapy, which freezes cervical tissue to induce localized necrosis, is the most commonly used ablative treatment. However, its implementation in low-resource settings is difficult because the refrigerant gas can be difficult to procure and transport, and is expensive. New cryotherapy devices that do not require an external supply of gas appear promising. Thermal coagulation, which burns cervical tissue to induce necrosis, has become more widely available in the last few years owing to its portability and the feasibility of using battery-powered devices. These two ablative treatments successfully eradicate 75%-85% of high-grade cervical lesions and have minor adverse effects.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  3 / 814 MEDLINE  
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PMID:28620926
Autor:Intaraphet S; Farkas DK; Johannesdottir Schmidt SA; Cronin-Fenton D; Søgaard M
Endereço:Boromarajonani College of Nursing, Khon Kaen, 40000, Thailand.
Título:Human papillomavirus infection and lymphoma incidence using cervical conization as a surrogate marker: a Danish nationwide cohort study.
Fonte:Hematol Oncol; 35(2):172-176, 2017 Jun.
ISSN:1099-1069
País de publicação:England
Idioma:eng
Resumo:Persistent human papillomavirus (HPV) infection may promote carcinogenesis by hyperactivation of the immune system. We, therefore, explored the associations between HPV infection and risk of Hodgkin and non-Hodgkin lymphoma in a nationwide cohort study using conization as a surrogate marker. We identified all Danish women who underwent conization between 1978 and 2011. We computed standardized incidence ratios and 95% confidence intervals for Hodgkin and non-Hodgkin lymphoma based on national cancer incidence rates. Among 87 435 women who underwent conization, we noted an increased incidence of Hodgkin (standardized incidence ratio 1.48, 95% confidence interval 1.05-2.02) but only a slight increase for non-Hodgkin lymphoma (standardized incidence ratio 1.10, 95% confidence interval 0.97-1.25). As measured by conization, HPV infection is associated with an increased risk of lymphoma. This association may be attributable to a chronic immune activation induced by persistent HPV infection and/or failure of the immune system both to clear HPV infection and to control lymphoma development. Copyright © 2015 John Wiley & Sons, Ltd.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Biomarkers)


  4 / 814 MEDLINE  
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PMID:28214204
Autor:Sopracordevole F; Clemente N; Alessandrini L; Di Giuseppe J; Cigolot F; Buttignol M; Ciavattini A; Canzonieri V
Endereço:Gynecological Oncology Unit, Centro di Riferimento Oncologico, National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy.
Título:Detection of occult endocervical glandular dysplasia in cervical conization specimens for squamous lesions.
Fonte:Pathol Res Pract; 213(3):210-216, 2017 Mar.
ISSN:1618-0631
País de publicação:Germany
Idioma:eng
Resumo:The aim of this work was to evaluate the incidence of occult cervical glandular intraepithelial neoplasia (CGIN) and adenocarcinoma of the cervix (AC) in women treated with CO2-laser conization for cervical intraepithelial neoplasia (CIN) or squamocellular cervical cancer (SCC). The medical records of all women with a histological diagnosis of squamous lesions of the uterine cervix (persistent CIN1, CIN2, CIN3 and SCC) who were subsequently treated with CO2-laser conization at our institution, during the period from January 1991 to December 2014, were analyzed in a retrospective case series. Among the 1004 women fulfilling the study inclusion/exclusion criteria, 77 cases (7.7%) of occult glandular lesions (CGIN and AC) were detected on the final cone specimen (48 cases of occult low-grade cervical glandular intraepithelial neoplasia (LCGIN), 25 cases of occult high-grade cervical glandular intraepithelial neoplasia (HCGIN), and four cases of occult "usual-type" AC). No difference in the mean age between women diagnosed with occult glandular lesions and women without occult glandular lesions on the final specimen emerged (39.1±9.3 vs 38.4±9.4, p=0.5). In women with occult LCGIN on cone specimen, mean follow-up of 48 months was reported (range 7-206 months) and no cases of progression to HCGIN or AC were observed. In conclusion, a relatively high rate of occult glandular lesions was found in women treated for squamous lesions. The natural history of CGIN is still uncertain and, in particular, there are some controversies as to whether LCGIN is a precursor lesion of HCGIN or AC. In this context the role of pathologists become very important since the appropriate diagnosis of these lesions could have potential implications in the clinical management of these patients.
Tipo de publicação: JOURNAL ARTICLE


  5 / 814 MEDLINE  
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PMID:28191698
Autor:Furugori M; Asai-Sato M; Katayama K; Hirahara F; Miyagi E
Endereço:Department of Obstetrics and Gynecology and Molecular Reproductive Science, Yokohama City University, Yokohama, Japan.
Título:Short- and long-term complications and the impact on quality of life after cervical conization by harmonic scalpel.
Fonte:J Obstet Gynaecol Res; 43(4):749-757, 2017 Apr.
ISSN:1447-0756
País de publicação:Australia
Idioma:eng
Resumo:AIM: The incidence of non-obstetrical complications after cervical conization is low, and women receive minimal postsurgical attention. In this study, we investigated whether women felt any discomfort after undergoing conization by harmonic scalpel, one of the hot-knife devices widely used in Japan. METHODS: Eighty-eight women aged 20-47 years who were still experiencing menstrual cycles and had undergone harmonic conization participated in a questionnaire survey regarding perisurgical complications and postsurgical changes in gynecological issues. Correlations between the occurrence of postoperative complications and clinical characteristics were analyzed. RESULTS: Regarding the complications immediately after the surgery, 37 women (45.1%) complained of postoperative bleeding that was heavier than their usual menstrual bleeding, and 14 (18.2%) reported that the postsurgical bleeding was greater than they had expected. Regarding long-term gynecological changes after conization, 27 women (30.7%) reported that the duration of menstrual bleeding had increased after the surgery, 20 (22.7%) indicated that pain during menstruation had changed, and 40 (45.5%) stated that the amount of menstrual bleeding had changed. Irregular genital bleeding outside of menstruation appeared in 23 women (26.4%). Additionally, 24 (27.6%) of the women reported that the conization procedure negatively impacted their quality of life. Finally, the occurrence of long-term atypical bleeding after the surgery was significantly correlated with the thickness and circumference of the tissue specimen. CONCLUSION: Several women experienced a significant change in quality of life after harmonic conization. Women who undergo conization should receive a comprehensive preoperative overview of the procedure and attentive postsurgical care.
Tipo de publicação: JOURNAL ARTICLE


  6 / 814 MEDLINE  
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PMID:28181670
Autor:Munro A; Codde J; Spilsbury K; Stewart CJ; Steel N; Leung Y; Tan J; Salfinger SG; Mohan GR; Semmens JB; Cohen PA
Endereço:Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
Título:Risk of persistent or recurrent neoplasia in conservatively treated women with cervical adenocarcinoma in situ with negative histological margins.
Fonte:Acta Obstet Gynecol Scand; 96(4):432-437, 2017 Apr.
ISSN:1600-0412
País de publicação:United States
Idioma:eng
Resumo:INTRODUCTION: Conservative treatments including cold knife cone biopsy (CKC) or loop electrosurgical excision procedure (LEEP) are fertility-preserving alternatives to hysterectomy. The risks of persistent cervical neoplasia in women with negative surgical margins following conservative treatment of adenocarcinoma-in-situ (AIS) are uncertain. This study aims to investigate the risk of persistent or recurrent cervical neoplasia [AIS, adenocarcinoma and/or high-grade cervical squamous intraepithelial neoplasia (CIN)] and compliance with follow-up recommendations in conservatively treated women with AIS and negative histopathological margins. MATERIAL AND METHODS: A retrospective, population-based study of Western Australian women treated by CKC or LEEP for AIS between 2001 and 2012. Histopathology reports were reviewed for demographic information, treatment procedures and clinicopathological factors. Primary outcomes were the diagnosis of cervical neoplasia during follow-up (defined as <12 months) and surveillance (≥12 months) periods. RESULTS: The cohort comprised 360 women, with 175 (48.6%) initially treated by CKC and 185 (51.4%) treated by LEEP. The median patient age at time of excisional treatment was 30.0 years (range 18-64 years) and the median follow-up time was 3.9 years (range six months to 12.2 years). During the follow-up and surveillance periods, seven (1.9%) women were diagnosed with CIN 2/3, 10 (2.8%) with AIS, and one (0.3%) with cervical adenocarcinoma, despite their initial excision specimens having negative histological margins. CONCLUSION: In this study, there was a low but significant risk of persistent or recurrent cervical neoplasia in women who had initial conservative management of AIS with negative histopathological margins.
Tipo de publicação: JOURNAL ARTICLE


  7 / 814 MEDLINE  
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PMID:28168772
Autor:Suzuki Y; Cho T; Mogami T; Yokota NR; Matsunaga T; Asai-Sato M; Hirahara F; Nojima M; Mori M; Miyagi E
Endereço:Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Título:Evaluation of endocervical curettage with conization in diagnosis of endocervical lesions.
Fonte:J Obstet Gynaecol Res; 43(4):723-728, 2017 Apr.
ISSN:1447-0756
País de publicação:Australia
Idioma:eng
Resumo:AIM: Endocervical curettage (ECC) at the time of conization has been reported to be effective for diagnosing cervical intraepithelial neoplasia and/or early stage cervical cancer. We aimed to verify the accuracy of ECC with conization. METHODS: We retrospectively analyzed the records of 540 patients with suspected neoplastic cervical lesions who underwent conization at the Yokohama City University Hospital from January 2008 to December 2015. To validate the effectiveness of ECC for evaluating endocervical lesions, histopathologic findings from ECC samples were compared with those from endocervical specimens obtained by conization. In patients who subsequently underwent hysterectomy, specimens of residual endocervical stump lesions were compared with the specimens obtained by ECC. RESULTS: ECC was performed in 58.9% of patients who underwent conization. Positive findings were only observed in 7.9%, while negative findings were found in 67.3% of ECC samples; however, 24.8% of the samples were inadequate for diagnosis. None of the patients had an upgraded diagnosis according to ECC results. The sensitivity of ECC in predicting endocervical stump lesions that were identified by conization specimens was 25.0%, the specificity was 94.2% and the positive predictive value was 55.0% (κ = 0.238; P < 0.001). ECC samples yielded a sensitivity of 42.9%, a specificity of 83.9%, and positive predictive value of 54.5% (κ = 0.284; P = 0.053) in predicting residual endocervical lesions in the uterus. CONCLUSIONS: As it offers low sensitivity and positive predictive value, ECC at the time of conization is of limited benefit for evaluating endocervical lesions.
Tipo de publicação: EVALUATION STUDIES; JOURNAL ARTICLE


  8 / 814 MEDLINE  
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PMID:28157826
Autor:Chevreau J; Mercuzot A; Foulon A; Attencourt C; Sergent F; Lanta S; Gondry J
Endereço:Department of 1Gynecology and 2Clinical Pathology, University Hospital of Amiens; and Picardie-Jules Vernes University, Amiens, France.
Título:Impact of Age at Conization on Obstetrical Outcome: A Case-Control Study.
Fonte:J Low Genit Tract Dis; 21(2):97-101, 2017 Apr.
ISSN:1526-0976
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: The aim of the study was to assess whether an age younger than 25 years at conization affected future pregnancy outcome as an independent factor. MATERIALS AND METHODS: A retrospective study of 115 women who underwent both loop electrosurgical excision procedure (LEEP) and subsequent pregnancy follow-up in a referral center was conducted. Two groups were considered: patients younger than 25 years at the time of LEEP (n = 42) and 25 years or older (n = 73). Analyzed data were occurrence of preterm adverse obstetrical event and, specifically, preterm labor (PL) and preterm rupture of membranes; stratification based on term of occurrence was performed: less than 37 weeks of amenorrhea (WA), less than 34 WA, and less than 26 WA. RESULTS: Patients characteristics were comparable in terms of excised specimen thickness and pathological analysis, as well as for tobacco intoxication during pregnancy. Although there was no difference of term at delivery or total number of preterm adverse obstetrical events, we found a significant increase of events (19% vs 4.1%) and PL (19% vs 0%) before 26 WA in the group of patients younger than 25 years. After adjusting for excised specimen thickness, the same results were found for thickness of 15 mm or less (respectively, 16.7% vs 3.3% and 16.7% vs 0%). For thickness of greater than 15 mm, only ratio of PL before 26 WA was higher in the group of patients younger than 25 years (33.3% vs 0%). CONCLUSIONS: Age younger than 25 years at the time of LEEP seems to be is associated with a more frequent occurrence of extremely early preterm adverse obstetrical events, particularly PL.
Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY


  9 / 814 MEDLINE  
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PMID:28129439
Autor:Giannella L; Fodero C; Boselli F; Rubino T; Mfuta K; Prandi S
Endereço:Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Italy.
Título:Age-related changes in pre- and post-conization HPV genotype distribution among women with high-grade cervical intraepithelial neoplasia.
Fonte:Int J Gynaecol Obstet; 137(1):72-77, 2017 Apr.
ISSN:1879-3479
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To assess the effect of age on pre- and post-conization HPV genotype distribution. METHODS: The present retrospective observational study included consecutive women with high-grade cervical intraepithelial neoplasia who underwent conization at the Cervical Cancer Screening Centre of Reggio Emilia, Italy, and University Hospital of Modena, Italy, between February 1, 2012, and October 31, 2014. Pre-conization and 6-month post-conization HPV genotyping results were compared between four age groups (<30, 30-39, 40-49, and ≥50 years) and age-related changes in the HPV genotypes present were evaluated. RESULTS: There were 162 patients included. The lowest occurrence of pre-conization high-risk and probable high-risk HPV genotypes was observed among patients aged at least 50 years when compared with younger patients (P=0.017). Conversely, women aged at least 50 years exhibited the highest level of post-conization high-risk and probable high-risk HPV genotypes (P=0.043). Additionally, an increasing incidence of recording identical pre- and post-conization HPV genotypes was associated with increasing age (P=0.024), as was increasing post-treatment recurrence of cervical intraepithelial neoplasia grade 2+ (P=0.030). CONCLUSION: The presence of high-risk and probable high-risk HPV genotypes was lowest among older patients before conization and was highest among these patients post-conization; post-treatment HPV clearance decreased with age and increasing age could be a risk factor for post-conization recurrence.
Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY


  10 / 814 MEDLINE  
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PMID:28125627
Autor:Jiang Y; Chen C; Li L
Endereço:Department of Gynecology, Liuzhou People's Hospital, Liuzhou, China.
Título:Comparison of Cold-Knife Conization versus Loop Electrosurgical Excision for Cervical Adenocarcinoma In Situ (ACIS): A Systematic Review and Meta-Analysis.
Fonte:PLoS One; 12(1):e0170587, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: The objective of this systematic review was to conduct a more comprehensive literature search and meta-analysis of original studies to evaluate the efficacy and safety of the loop electrosurgical excision procedure (LEEP) versus cold-knife conization (CKC) in conservative surgical treatment of cervical adenocarcinoma in situ (ACIS) for women who have not completed childbearing. METHODS: Systematic searches were conducted in the PUBMED, EMBASE, Cochrane, and China National Knowledge Infrastructure (CNKI) databases to identify all potential studies involving patients with ACIS treated with LEEP versus CKC published until December 2015. RESULTS: Eighteen retrospective studies were included in this systematic review. All the 18 included studies reported the rate of positive margins, and the results of the individual studies varied. The positive margins were 44% (267/607) after LEEP and 29% (274/952) after CKC. The pooled meta-analysis exhibited significantly different outcome (RR, 1.55; 95% CI, 1.34-1.80, P<0.00001) without significant heterogeneity (P = 0.34). The residual rate following LEEP was 9.1% (17/186) and 11% (39/350) after CKC in re-cone or hysterectomy cases. Recurrent ACIS following LEEP was reported in 10 of 142 (7.0%) cases compared to 10 of 177 (5.6%) cases following CKC. There were no significant differences in the residual rate (RR, 1.02; 95% CI, 0.60-1.72, P = 0.95) or recurrence rate (RR, 1.13; 95% CI, 0.46-2.79; P = 0.79) between the two procedures. CONCLUSIONS: The present systematic review demonstrates that both LEEP and CKC are safe and effective for the conservative treatment of ACIS. LEEP appears to be as equally effective as CKC regarding the residual and recurrence rates. Due to the findings showing that LEEP achieves comparable oncologic outcomes with fewer obstetric complications to that of CKC, LEEP may be the preferred option in patients whose fertility preservation is important. However, further prospective studies with a larger sample size and longer follow-up periods are needed to establish the superiority of either procedure.
Tipo de publicação: JOURNAL ARTICLE; META-ANALYSIS; REVIEW



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