Patients with positive cone biopsy margins face the highest risk of persistent or recurrent cervical intraepithelial neoplasia (CIN). 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. 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). International Journal of Gynecological Cancer. Journal of Applied Clinical Medical Physics. Patients include those for LEEP–Cone with traditional excisional indications and those who underwent LEEP–Cone at the operating physician's discretion. •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. Negative margins were found in 71.0% (n=49) of all cones, whereas positive margins were reported in 29.0% (n=20). 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. On multivariate analysis, two-step discrepancy and parity remained predictive. A template‐based vaginal cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization line, along with treatment time. A design for postoperative management and avoiding these situations is offered. 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%. 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 … By continuing you agree to the use of cookies. Laser conization can be excisional or destructive by vaporization, and hence, it can be used for treatment as well. A positive ECC … A positive margin was defined as AIS within 1 mm of the surgical margin. The “top hat” is more appropriate as parity and age increase. A resection depth between 10-19.9 mm led to 73.0% negative margin cones. Cryotherapy, cold knife, or LEEP is preferable when no treatment is being done. 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). This study defines populations where a single pass technique with the LEEP is appropriate. This would benefit women because, unlike cold-knife cone … For the first time in 4 years I had a completely normal pap 3 months after the cone biopsy. CIN II/III-positive margin rates of 19% and 16% have been reported for cold-knife conization and LEEP respectively . This was a … The loop core specimens were cut radially in a fashion identical to that used for the cold-knife cone biopsy specimens. The cervical canal above the region of cone biopsy may also be scraped to remove cells for evaluation. Conization was then performed with a cold knife, laser and fine‐needle electrode. Statistical … 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%). Age > 35 was the greatest percentile predictor of dysplasia in the top hat, and 91.5% of women < 21 had normal top hat pathology. If positive margins are noted on the cone specimen, a repeat CKC is recommended. Statistical analysis was used to compare preoperative factors with the resultant pathologic results. To read the full-text of this research, you can request a copy directly from the authors. Given the possibility of skip lesions, hysterectomy is recommended for … ResearchGate has not been able to resolve any references for this publication. OBJECTIVE To determine the optimal cone size to achieve a reliable sensitivity and specificity for clear surgical margins after cold knife conization (CKC). However, concerns related to LEEP include the interpretability of the resection margins, positive margins, and the tissue fragmentation. line were also compared to the plans with an 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 apex doses were monitored at 5 mm depth doses (eight points) where a prescription dose (Rx) of 6 Gy was prescribed. history, pathologic findings, including the dimensions of the cone specimens and margin status, as well as outcomes. 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 … 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. 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. Statistical … 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 … 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. Indications for cold-knife cone biopsies and LEEP–Cone biopsies include the following: positive ECC, unsatisfactory colposcopy, and two-step discrepancy. conflicting: positive margins and extension of glandular in-volvement in the cone [10]. Almeida, M.P. ResearchGate has not been able to resolve any citations for this publication. 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%). Managing Biopsy Reports Of LSIL/HSIL Using LAST* Terminology • … Although there is considerable variation, stud-ies generally have reported a 30% incidence of positive margins. You can request the full-text of this article directly from the authors on ResearchGate. 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 … 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). Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes. Negative margins were found in 71.0% (n=49) of all cones, whereas positive margins were reported in 29.0% (n=20). A resection depth between 10-19.9 mm led to 73.0% negative margin cones. The 10× 10-mm loop was used to excise a central cervical core of tissue. 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 excised cone, the 12 o’clock position was identified by a suture. … Table 2. 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. 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. Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. Salcedo, D. Gottlieb, D.P. minutes). 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 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 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. An endocervical margin was considered positive when dysplasia or … Women under 21 years of age should have a single pass LEEP technique. The follow-up period was defined as the time between initial AIS … All loop specimens were sectioned serially and submitted in their entirety for histopathologic examination. 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. 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. At an incubation 37 degrees C 40 CCa-sera (33.3%) and 7 control sera (6%) were positive. Just last week I had my second follow pap and it came back abnormal w/CIN 1 again. Hemostasis was obtained by Sturmdorf sutures, laser and electrocoagulation, respectively. 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. 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… polyDNA discusses the survey and recommends Gene-Eden-VIR against the latent HPV virus. [Lymphocytotoxic antibodies in cervical cancer]. If there is sufficient cervix left after the LEEP procedure, I would strongly recommend that you undergo a cold-knife cone … Cotesting at 12 & 24 months Then continued Follow-up . 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. © 2008-2021 ResearchGate GmbH. All rights reserved. Copyright © 2021 Elsevier B.V. or its licensors or contributors. POSITIVE MARGINS IN COLD KNIFE CONE: PREVALENCE AND RESIDUAL LESIONS R.V. The incidence of recurrent dysplasia when the margins are positive has been reported to be as high as 50%.6,7 Next, the specimen was placed in a … This is called endocervical curettage (ECC). Fragmentation of LEEP and CKC specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial lesions, and indeterminate margins. A LEEP–Cone may not be necessary for all patients with traditional cone indications. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. LEEP is an in-office procedure with less discomfort and fewer complications than CKC. 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. Does the apex optimization line matter for single-channel vaginal cylinder brachytherapy planning? 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." 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. We use cookies to help provide and enhance our service and tailor content and ads. 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. Indeed, patients who are unable to comply 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. Conclusion: Expectant management is reasonable for patients with CIN III and positive margins after cold-knife … In this study, the mean cone depth of LEEP was 11 mm, and the full-term live birth rate was 83.3% (5/6). … 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. 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 objective of this study is to test the impact of the use of the apex optimization line for new vaginal cylinder (VC) applicators. 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. Copyright © 2005 Elsevier Inc. All rights reserved. However, due to the very small sample size of these studies, further clinical trials are warranted to explore the optimal cone … 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 . https://doi.org/10.1016/j.ygyno.2005.09.015. 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 | … The positive margins were 44% (267/607) after LEEP and 29% (274/952) after CKC. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. This can lead to very frustrating … 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. 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). In the Department of Pathology, the cone depth was measured vertically from the excised specimen. 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). 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). In another study, the rates of margin involvement with these same methods were 5.7% and 33% respectively [30] . A total of 248 women underwent LEEP–Cone. 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). VC surface doses (eight points) were also analyzed. 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. 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. Discrepancy and parity remained predictive women under 21 years of age should have a single pass technique! Margin involvement with these same methods were 5.7 % and a specificity of 64 % cylinder planning reduced intra‐... A resection depth between 10-19.9 mm led to 73.0 % negative margin cones 64 % excisional indications and those underwent! Were cut radially in a fashion identical to that used for treatment as as... From the authors on researchgate and fine‐needle electrode extension of glandular in-volvement in the Department of Pathology the... Or contributors provide and enhance our service and tailor content and ads parity remained predictive 12 & months. 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