Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; surgery ; Colposcopy ; Conization ; Electrosurgery ; Female ; Humans ; Hysterectomy ; methods ; Neoplasm Regression, Spontaneous ; Uterine Cervical Neoplasms ; diagnosis ; pathology ; surgery ; Vaginal Smears

OBJECTIVETo explore the optimal diagnosis and treatment methods for grade III cervical intraepithelial neoplasia (CINIII).

METHODSNinety-eight cases of CINIII initially diagnosed by colposcopical biopsy in our hospital from 2000 to 2008 were analyzed retrospectively in terms of the diagnosis, treatment and outcome.

RESULTSAll the patients received cervical conization including 53 with cold knife conization and 45 with LEEP conization. Obvious differences were noted between cervical conization and colposcopical biopsy results in 15 cases (15.3%) diagnosed to be invasive carcinoma. Fifty-two patients received hysterectomy after conization. A significant difference occurred in pathological diagnosis between cervical conization and hysterectomy groups (P<0.01). There were low-grade cervical intraepithelial lesions in most cases of hysterectomy group and only 4 cases had CINIII. Thirty-one patients refused hysterectomy for concerns of fertility or because of a young age and were followed up after conization. One patient with cervical carcinoma in situ experienced recurrence in 3 years and received a second hysterectomy. The other patients including those in hysterectomy group showed no recurrence till now.

CONCLUSIONCervical conization is the golden standard for the diagnosis of CINIII and can not be replaced by colposcopical biopsy. Cervical conization may serve as the primary choice for treatment of CINIII with negative margin, but the patients should be followed up closely after the operation.

Adult ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Cervix Uteri ; pathology ; surgery ; Conization ; methods ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Uterine Cervical Neoplasms ; pathology ; surgery

BACKGROUNDConization is being widely accepted for diagnosis and treatment of cervical intraepithelial neoplasia (CIN). There is controversy as to which factors are most predictive of a positive cone margin and the clinical significance of it. We conducted this study to identify the predictive factors and to evaluate the clinical significance of a positive cone margin in CIN III patients.

METHODSA retrospective review was conducted of 207 patients who had undergone conization due to CIN III from January 2003 to December 2005 at Peking Union Medical College Hospital. Of these, 67 had a subsequent hysterectomy. Univariate and multivariate analysis were utilized to define the predictive factors for a positive cone margin, and to compare the pathologic results of conization with subsequent hysterectomy.

RESULTSOne hundred and fifty-one (72.9%) were margin free of CIN I or worse, 37 (17.9%) had CIN lesions close to the margin and 19 (9.2%) had margin involvement. A total of 56 cases (27.1%) had positive cone margins (defined as the presence of CIN at or close to the edge of a cone specimen). Univariate analysis showed that the parity, cytological grade, multi-quadrants of CIN III by punch biopsy, gland involvement, as well as the depth of conization were significant factors correlated with a positive cone margin (P < 0.05). However the age, gravidity, grade of dysplasia in punch biopsy, as well as the cone methods were not significantly correlated (P > 0.05). Multivariate analysis revealed that the cytological grade (OR = 1.92), depth of conization (OR = 2.03), parity (OR = 3.02) and multi-quadrants of CIN III (OR = 4.60) were significant predictors with increased risk for positive margin. The frequency of residual CIN I or worse in hysterectomy specimens was found to be 55.6% (20/36) in patients who were margin free, 71.4% (15/21) in patients with CIN occurring close to margin, and 80.0% (8/10) in patients with margin involvement. The frequency of residual CIN III or worse was found to be 13.9% (5/36), 23.8% (5/21) and 50.0% (5/10) respectively in different groups.

CONCLUSIONSCytological grade, depth of conization, parity and multi-quadrants of CIN III in punch biopsy were significant factors with increased risk in predicting a positive cone margin. Margin status of conization did not mean the presence or absence of CIN, but rather the varied frequency of residual CIN in specimens of subsequent hysterectomy. In view of this fact, it is suggested that the margin status of conization be a valuable surrogate marker for clinical management of CIN III.

Adult ; Cervical Intraepithelial Neoplasia ; diagnosis ; pathology ; surgery ; Cervix Uteri ; pathology ; Conization ; methods ; Female ; Humans ; Hysterectomy ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Retrospective Studies ; Young Adult

OBJECTIVE: To analyze the clinical pathologic characteristics of cervical intraepithelial neoplasia grade III (CINIII ) and to explore optimal surgery for CINIII patients. METHODS: The clinical pathologic characteristics, surgical treatments, prognosis and history of 383 CINIII patients, who hospitalized from August 2005 to December 2010, were reviewed and analyzed. Among the patients, 213 (55.6%) received cold-knife conization surgery and 170 (44.4%) received ordinary electric knife conization surgery. RESULTS: There was no significant statistic difference between cold-knife conization group and ordinary electric-knife conization group on the level of clearance of the pathologic tissues and the cervical cone diameter and cone high. Intraoperative blood loss was (13.1±5.2) mL and (25.5±17.2) mL. Bleeding of electric knife conization group, compared with that of the cold knife conization group, decreased by nearly 50%. The difference between the 2 groups was significant (P<0.01). Pathological examination after conization operation indicated that 350 out of the 383 patients didn't show pathological upgrade while 33 patients showed pathological development, among which 21 were diagnosed with invasive cervical cancer at Ia1 clincal stage, 7 atIa2 clincal stage and 5 atIb1 clincal stage. In 3 cases (14.3%) Ia1 cervical cancer patients, fertility requirements and negative margins with cervical conization were closely followed up, and one patient (4.8%) with positive margin and fertility requirements had re-conecut. The remaining 17 (80.9%) had resected the uterus outside the fascia (or plus attachments) . All the 12 patients with invasive cervical cancer at Ia2 orIb1 clinical stage received radical hysterectomy. No tumor recurrence was observed in the 383 patients. CONCLUSION Treatment optimazation of CINIII patients should be based on clinical pathological diagnosis and individual requirements. Both cervical conization surgery and total hysterectomy have been proved safe and practical for CINIII patients.
Adult ; Aged ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Conization ; methods ; Female ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Grading ; Uterine Cervical Neoplasms ; pathology ; surgery

Adult ; Aged ; Cervical Intraepithelial Neoplasia ; pathology ; surgery ; Cervix Uteri ; pathology ; surgery ; Conization ; methods ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; pathology ; surgery ; Uterine Cervical Neoplasms ; pathology ; surgery

OBJECTIVE: To explore appropriate treatment modality of microinvasive cervical cancer (MIC) and to analyze prognosis and risk factors of recurrence. METHODS: A cohort of 324 Chinese patients with MIC diagnosed and treated at Peking Union Medical College Hospital was retrospectively reviewed. Demographic features, treatment modalities, pathologic parameters, risk factors of residual disease, survival and risk factors of recurrence were analyzed. RESULTS: Of all patients, 280 cases were staged IA1 and 44 cases staged IA2 MIC. Twenty-five cases (7.7%) were found to have lympho-vascular space involvement (LVSI), but no parametrial involvement or ovarian metastasis was detected. Only one staged IA2 patient with LVSI was found to have lymph node metastasis. 32.4% patients (82/253) had residual diseases after conization. No significant difference of LVSI, lymph node metastasis and residual disease after coniztion was found between stage IA1 and IA2 MIC patients. Multivariate logistic analysis showed positive margin was the only independent risk factor of residual disease after conization (odds ratio [OR], 4.18; p<0.001). Recurrence occurred in five cases, but no mortality was found. Progression-free survival for stage IA1 patients treated by conization or hysterectomy was similar (92.3% and 98.8%, p=0.07). Cox regression analysis revealed LVSI as an independent risk factor for recurrence in stage IA1 patients (OR, 12.14; p=0.01). CONCLUSION: For stage IA1 patients with negative resection margin and no LVSI, conization can be an ideal treatment modality. For stage IA2 patients, more conservative surgery such as simple hysterectomy may be considered. LVSI is an independent risk factor for recurrence in patients with stage IA1 cervical cancer.
Adult ; Aged ; Cohort Studies ; Conization/methods ; Female ; Humans ; Hysterectomy ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Neoplasm, Residual ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Uterine Cervical Neoplasms/pathology/*surgery ; Young Adult

OBJECTIVETo analyze the characteristics of cervical minimal deviation adenocarcinoma (MDA) and the methods of diagnosis and treatment.

METHODSA retrospective study was carried out to evaluate the clinical and pathological data of 15 patients with MDA treated from 1992 to 2007.

RESULTSThe average age of the 15 patients was 42.3 years. The main symptoms were increased discharge and irregular vaginal bleeding. Preoperative Pap smears showed adenocarcinoma in 3 cases (27.3%). The diagnosis of MDA was confirmed in 8 cases by cervical punch biopsies (53.3%) and 2 cases by conization. Several cysts were noted in sections of the endocervix. Microscopic examination showed glands irregular in size and shape. However, the deviation of tumor cells was minimal. Immunohistochemistry revealed positive expression of CEA and alpha-SMA. The mean follow-up time was 51.0 months. The overall 5-year survival rate was 85.7%. Four cases experienced recurrence in the vagina and pelvis at 2 years after operation. Three cases died of the disease relapse with an average survival time of 36.3 months.

CONCLUSIONCervical minimal deviation adenocarcinoma is rare, with minimal deviation of cell shape from the normal cervical cells and difficult in diagnosis. A deep biopsy or conization is necessary when punch biopsy is not sufficient for diagnosis. Immunohistochemistry is helpful to make an accurate diagnosis. Surgery is the first choice for cervical minimal deviation adenocarcinoma. Radiotherapy and/or chemotherapy should be given if needed. The prognosis can be improved if a proper treatment plan is carried out.

Actins ; metabolism ; Adenocarcinoma ; diagnosis ; pathology ; therapy ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoembryonic Antigen ; metabolism ; Cervix Uteri ; pathology ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Conization ; Epirubicin ; administration & dosage ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Papanicolaou Test ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms ; diagnosis ; pathology ; therapy ; Vaginal Smears