These traditional indications were evaluated in this study to assess the presence of dysplasia in the top hat and dysplasia found at the margin of resection in LEEP or LEEP–Cone specimens. In the case of positive endocervical margins, repeat coni-zation may benefit some patients, since screening and monitor - ing of the progression of residual lesions in the cervical canal are difficult tasks. The retrospective data reported regarding LEEP–Cones reveal increased parity to predict dysplasia in the top hat and two-step discrepancy as a poor predictor of dysplasia in the top hat. Positive or close histopathological margins have been associated with an increased risk of AIS persistence and ... to cold-knife cone biopsy for the outcomes of post-treat-ment persistence and recurrence, and adenocarcinoma, loop excision could be recommended as an appropriate treatment option for AIS in selected patients. After 2 1/2 years of repeat paps, colposcopies/biopsy and my CIN 1 turning into CIN 3/Carcinoma in situ I underwent a cold knife cone biopsy 8 months ago with clear margins. Positive or close histopathological margins have been associated with an increased risk of AIS persistence and recurrence.13 A 2014 systematic review14 reported higher rates of incomplete excision with LEEP (51%) than with CKC (30%) or laser cone (28%) using pooled data and reported rates of recurrence of AIS ranging from 9% to 29% after LEEP and from 6% to 11% after CKC. Conclusion: Expectant management is reasonable for patients with CIN III and positive margins after cold-knife … The incidence of recurrent dysplasia when the margins are positive has been reported to be as high as 50%.6,7 Hemostasis was obtained by Sturmdorf sutures, laser and electrocoagulation, respectively. ResearchGate has not been able to resolve any references for this publication. CIN II/III-positive margin rates of 19% and 16% have been reported for cold-knife conization and LEEP respectively . If positive margins are noted on the cone specimen, a repeat CKC is recommended. At an incubation temperature of 22 degrees C 36 CCa-sera (30%) were positive in comparison to 11 sera of the control group (9.5%). This was a … Cryotherapy, cold knife, or LEEP is preferable when no treatment is being done. In the Department of Pathology, the cone depth was measured vertically from the excised specimen. Just last week I had my second follow pap and it came back abnormal w/CIN 1 again. Journal of Applied Clinical Medical Physics. https://doi.org/10.1016/j.ygyno.2005.09.015. Fragmentation of LEEP and CKC specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial lesions, and indeterminate margins. However, due to the very small sample size of these studies, further clinical trials are warranted to explore the optimal cone … •55% with positive margins had persistent disease •23% with negative margins had persistent disease •Risk of positive margin less after cold knife cone than after LEEP Histological AIS Margin status and persistence AJOG 2007;197:195.3a-195.e8. Patients include those for LEEP–Cone with traditional excisional indications and those who underwent LEEP–Cone at the operating physician's discretion. … The loop core specimens were cut radially in a fashion identical to that used for the cold-knife cone biopsy specimens. Age > 35 was the greatest percentile predictor of dysplasia in the top hat, and 91.5% of women < 21 had normal top hat pathology. We retrospectively reviewed patients undergoing LEEP–Cone procedures performed at the University of Oklahoma Health Science Center from February of 1994 to July of 2002. Conization was then performed with a cold knife, laser and fine‐needle electrode. … polyDNA discusses the survey and recommends Gene-Eden-VIR against the latent HPV virus. A resection depth between 10-19.9 mm led to 73.0% negative margin cones. MATERIAL AND METHODS The medical reports of patients who had high-grade cervical intraepithelial lesions, carcinoma in situ, or stage 1A1 microinvasive carcinoma in their CKC specimens between June 2008 and January 2015 … Almeida, M.P. Women under 21 years of age should have a single pass LEEP technique. 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). Risk factors for positive margins and residual lesions after cold knife conization (CKC) for high-grade cervical intraepithelial neoplasias (CIN) were assessed in women of child-bearing age. A positive margin was defined as AIS within 1 mm of the surgical margin. This is called endocervical curettage (ECC). © 2008-2021 ResearchGate GmbH. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. Managing Biopsy Reports Of LSIL/HSIL Using LAST* Terminology • … The follow-up period was defined as the time between initial AIS … Copyright © 2005 Elsevier Inc. All rights reserved. On multivariate analysis, two-step discrepancy and parity remained predictive. VC surface doses (eight points) were also analyzed. Old VC applicator plans also showed a statistically significant reduction (P < 0.00001) due to the Ir‐192 source anisotropic effect at the apex region, but the percent reduction over the Rx was only −7 ± 9%. Rochester, NY (PRWEB) January 01, 2014 -- In its December 2013 survey, polyDNA found that up to 74% of respondents considering cold knife conization to remove HPV cervical lesions were unaware that they might need more than one procedure. ResearchGate has not been able to resolve any citations for this publication. Given the possibility of skip lesions, hysterectomy is recommended for … A design for postoperative management and avoiding these situations is offered. The use of the apex optimization line is important in order to avoid significant additional cold doses (−24 ± 2%) at the prescription depth (5 mm) of the apex, specifically for the new VC applicators that have thicker tops. Increased evidence of lymphocytotoxic antibodies in the sera of patients with cervical carcinoma supports the assumption, that various immune reactions may be involved in this disease. Does the apex optimization line matter for single-channel vaginal cylinder brachytherapy planning? The cervical canal above the region of cone biopsy may also be scraped to remove cells for evaluation. Indications for cold-knife cone biopsies and LEEP–Cone biopsies include the following: positive ECC, unsatisfactory colposcopy, and two-step discrepancy. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Preoperative predictors of positive margins after loop electrosurgical excisional procedure–Cone, Loop electrosurgical excisional procedure, Loop electrosurgical excisional procedure–cone. Inject a premixed solution of 2% xylocaine and epinephrine in a concentration of 1:200,000 into the cervical stroma at 12 o’clock outside the intended margin. At an incubation temperature of 15 degrees C cold reacting lymphocytotoxic antibodies were detected in 26 patients' sera (21.7%) and in 13 control sera (11.2%). Statistical … The 10× 10-mm loop was used to excise a central cervical core of tissue. By continuing you agree to the use of cookies. RESULTS: Of 132 women treated with cone biopsy for AIS, 95 (72%) were managed conservatively after cold knife cone or loop electrical excisional procedure alone; 37 (28%) eventually underwent hysterectomy. Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes. All loop specimens were sectioned serially and submitted in their entirety for histopathologic examination. Indeed, patients who are unable to comply Request PDF | On May 1, 2015, R V Almeida and others published POSITIVE MARGINS IN COLD KNIFE CONE: PREVALENCE AND RESIDUAL LESIONS: IGCS-0073 Cervical Cancer | … Univariate analysis found CIN III on histology and parity to be predictive of dysplasia in the top hat and two-step discrepancy to predict absence of dysplasia. POSITIVE MARGINS IN COLD KNIFE CONE: PREVALENCE AND RESIDUAL LESIONS R.V. The positive margins were 44% (267/607) after LEEP and 29% (274/952) after CKC. All rights reserved. A resection depth between 10-19.9 mm led to 73.0% negative margin cones. Although there is considerable variation, stud-ies generally have reported a 30% incidence of positive margins. There was no statistically significant difference in the depths of the excised cone specimens between the resident and the staff gynecologist group (Table 2).After classification of the depth of excision according to cut-off values of 10, 15, or 20 mm, still no significant difference was found between groups (Table 2).With regard to the proportion of positive resection margins… Copyright © 2021 Elsevier B.V. or its licensors or contributors. In this study, the mean cone depth of LEEP was 11 mm, and the full-term live birth rate was 83.3% (5/6). International Journal of Gynecological Cancer. For a “cold-knife” cone, use a #11 surgical blade to begin a circular incision starting at 12 o’clock on the face of the cervix. Persisting or recurrent disease was more common in patients in whom both the endocervical and the ectocervical cone margins were involved than in those in whom only the ectocervical or the endocervical margin was positive (52% versus 17% and 21%, respectively, P <.001). Cotesting at 12 & 24 months Then continued Follow-up . Pathological characteristics of margin-positive and margin-negative patients - "Optimal cone size to predict positive surgical margins after cold knife conization (CKC) and the risk factors for residual disease." In the excised cone, the 12 o’clock position was identified by a suture. You can request the full-text of this article directly from the authors on ResearchGate. In another study, the rates of margin involvement with these same methods were 5.7% and 33% respectively [30] . However, by adding the apex optimization line to the new VC applicator plans, the plans improved 5‐mm depth doses (−7 ± 9% over Rx) that were not statistically different from old VC applicator plans (P = 0.923), along with apex VC surface doses (−22 ± 10% over old VC vs −46 ± 7% without using apex optimization line). Loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC) are often used for the treatment of high-grade cervical intraepithelial lesions. The median age of diagnosis was 29 years (range, 17-47) in the conservative management group and 40 years (range, 25-72) in the hysterectomy group (P < 0.0001). For the first time in 4 years I had a completely normal pap 3 months after the cone biopsy. Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. Statistical analysis was used to compare preoperative factors with the resultant pathologic results. Some studies suggest that performing the cone biopsy with a knife (the traditional “cold-knife cone biopsy”) leads to a more accurate assessment of the surgical margins. An endocervical margin was considered positive when dysplasia or … conflicting: positive margins and extension of glandular in-volvement in the cone [10]. If there is sufficient cervix left after the LEEP procedure, I would strongly recommend that you undergo a cold-knife cone … Todeschini, S.A. Pessini Gynecology,Universidade Federal de Ciencias da Saude de Porto Alegre e Santa Ca sa de Porto Alegre, Porto Alegre, Brazil Objectives: To identify the frequency of positive margins in surgical specimen of cold knife cone (CKC) for … Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. A positive ECC … Laser conization can be excisional or destructive by vaporization, and hence, it can be used for treatment as well. The rate of positive margins for LEEP with a mean cone depth of 8 mm was not significantly higher than that for CKC with a mean cone depth of 15 mm. This can lead to very frustrating … Salcedo, D. Gottlieb, D.P. The apex doses were monitored at 5 mm depth doses (eight points) where a prescription dose (Rx) of 6 Gy was prescribed. However, the fact that the margins of the biopsy specimen were positive for precancerous cells means that the possibility of invasive cancer has not been definitively ruled out. LEEP is an in-office procedure with less discomfort and fewer complications than CKC. A total of 245 women underwent cervical conization (cold knife cone or loop electro-surgical excisional cone) for the following indications: CIN grade 2 or 3, positive … Summary Excision is widely used as treatment for HSIL of the uterine cervix (CIN2 and Preferred over ablation with large lesions (>75% of cervix area), lesions extending into the … The “top hat” is more appropriate as parity and age increase. A template‐based vaginal cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization line, along with treatment time. Review the indications and techniques of LEEP and cold knife cone Compare risks of LEEP vs. cold knife cone Review the failure rates and risk factors for recurrence of disease after LEEP and cone . A total of 248 women underwent LEEP–Cone. To read the full-text of this research, you can request a copy directly from the authors. However, concerns related to LEEP include the interpretability of the resection margins, positive margins, and the tissue fragmentation. [Lymphocytotoxic antibodies in cervical cancer]. June 18 another cold knife cone biopsy to determine if my hyst could be done as we hoped/plan/expected (looking to see if there were more lesions and how large/deep they were) June 19 returned to the hospital for my LAVH to remove just my cervix and uterus My CKC on June 18 removed one more lesion (about 1mm across and 1mm deep). OBJECTIVE To determine the optimal cone size to achieve a reliable sensitivity and specificity for clear surgical margins after cold knife conization (CKC). Relating these results to the clinical stages of the carcinoma, the highest percentage of lymphocytotoxicity was found in the sera of patients with an early stage of the disease. The objective of this study is to test the impact of the use of the apex optimization line for new vaginal cylinder (VC) applicators. Negative margins were found in 71.0% (n=49) of all cones, whereas positive margins were reported in 29.0% (n=20). This would benefit women because, unlike cold-knife cone … The new VC applicator plans without apex optimization line presented significantly lower 5‐mm depth doses over the Rx (on average −31 ± 7%, P < 0.00001) due to thicker VC tops (3.4 ± 1.1 mm thicker with the range of 1.2–4.4 mm) than the old VC applicators. In a multivariable logistic regression the human immunodeficiency virus–seropositive women had a 2-fold increased risk of having a positive cone biopsy margin (odds ratio, 2.25; 95% confidence interval, 1.07-4.76). Conclusion: If the presence of positive cone biopsy specimen margins represents the potential for disease progression, then our findings of a positive margin rate of … At an incubation 37 degrees C 40 CCa-sera (33.3%) and 7 control sera (6%) were positive. minutes). Patients with positive cone biopsy margins face the highest risk of persistent or recurrent cervical intraepithelial neoplasia (CIN). 50.0% (33/66) of the patients with positive margins on the first pass had dysplasia or worse (CIN I–III or CA) in the second pass (top hat), compared to 6.6% (12/182) of the patients with a negative first pass (P < 0.0001). New single channel VC applicators (Varian) that have different top thicknesses but the same diameters as the old VC applicators (2.0 cm diameter, 2.3, 2.6, 3.0, and 3.5 cm) were compared using phantom studies. Old VC applicator plans without the apex optimization, Sera of 120 patients, suffering from cervical cancer (CCa) of different clinical stages (stage 0: n = 27; stage I: n = 29; stage II--IV: n = 64) as well as the sera of 116 healthy individuals as control group were examined for lymphocytoxic antibodies by microlymphocytotoxicity tests, variated in incubation temperatures (15 degress -- 22 degrees -- 37 degrees C) and incubation times (30--180, Access scientific knowledge from anywhere. 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 We use cookies to help provide and enhance our service and tailor content and ads. Statistical … A LEEP–Cone may not be necessary for all patients with traditional cone indications. 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