Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Long Term Outcomes of Laser Conization for High Grade Cervical Intraepithelial Neoplasia in Thai Women

  • Wongtiraporn, Weerasak (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Laiwejpithaya, Somsak (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Sangkarat, Suthi (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Benjapibal, Mongkol (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Rattanachaiyanont, Manee (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Ruengkhachorn, Irene (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Chaopotong, Pattama (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Laiwejpithaya, Sujera (Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Published : 2014.10.11
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Abstract

Aim: To report long term outcomes of laser conization for high grade cervical intraepithelial neoplasia (CIN) in Thai women. Materials and Methods: A retrospective cohort study was conducted in patients undergoing laser conization due to abnormal cervical cytology suggesting neoplasia during 1989 to 1994 and having follow-up data until December 2010. Conization was performed under colposcopy using a 0.5-mm $CO_2$ laser beam with power density of $18,000-20,000watts/cm^2$, and the surgical base was vaporized using a low power defocused beam. The follow-up protocol included cervical cytology and colposcopy. Long term outcome measures were failure rate (persistence and recurrence), post-conization status of transformation zone, and obstetric outcomes. Results: Of 104 patients undergoing conization, 71 had therapeutic conization for high grade CIN and were followed up for a median time of 115 (range 12-260) months. There was one case of persistent and one of recurrent disease comprising a failure rate of 2.8%. The post treatment transformation zone was well visualized in 68.3% of 63 patients with an intact uterus. Sixteen patients achieved 25 pregnancies; none had second trimester miscarriage. The obstetric outcomes were unremarkable. Conclusions: Laser conization under colposcopic visualization for the treatment of high grade CIN in Thai women has a low failure rate of 2.8%. The post-conization transformation zone could not be evaluated completely in approximately 30% of cases; therefore the follow-up protocol should include both cytology and colposcopy. Obstetric outcomes are not adversely affected by this therapeutic procedure.

Keywords

References

  1. Bar-Am A, Daniel Y, Ron IG, et al (2000). Combined colposcopy, loop conization and laser vaporization reduces recurrent abnormal cytology and residual disease in cervical dysplasia. Gynecol Oncol, 78, 47-51. https://doi.org/10.1006/gyno.2000.5825
  2. Baser E, Ozgu E, Erkilinc S, et al (2013). Clinical outcomes of cases with cervical dysplasia absent in cold knife conization specimens. Asian Pacific J Cancer Prev, 14, 6693-6.. https://doi.org/10.7314/APJCP.2013.14.11.6693
  3. Bekassy Z (1997). Long-term follow-up of cervical intraepithelial neoplasia treated with minimal conization by carbondioxide laser. Lasers Surg Med, 20, 461-6. https://doi.org/10.1002/(SICI)1096-9101(1997)20:4<461::AID-LSM13>3.0.CO;2-E
  4. Dorsey JH, Diggs ES (1979). Microsurgical conization of the cervix by carbondioxide laser. Obstet Gynecol, 54, 565-70.
  5. Duggan BD, Felix JC, Muderspach LI, et al (1999). Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized prospective study. Am J Obstet Gynecol, 180, 276-82. https://doi.org/10.1016/S0002-9378(99)70200-0
  6. Forsmo S, Hansen MH, Jacobsen BK, Qian P (1996). Pregnancy outcome after laser surgery for cervical intraepithelial neoplasia. Acta Obstet Gynecol Scand, 75, 139-43. https://doi.org/10.3109/00016349609033306
  7. Khuhaprema T, Attasara P, Sriplung H, et al (2012). Cancer in Thailand. Vol. VI, 2004-2006. Bangkok, National Cancer Institute, Department of Medical Service, Ministry of Public Health.
  8. Laiwejpithaya S, Rattanachaiyanont M, Benjapibal M, et al (2008). Comparison between Siriraj liquid-based and conventional cytology for detection of abnormal cervicovaginal smears: a split sample study. Asian Pacific J Cancer Prev, 9, 575-80.
  9. Lu CH, Liu FS, Kuo CJ, et al (2006). Prediction of persistence or recurrence after conization for cervical intraepithelial neoplasia III. Obstet Gynecol, 107, 830-5. https://doi.org/10.1097/01.AOG.0000206777.28541.fc
  10. Mathevet P, Dargent D, Roy M, Beau G (1994). A randomized study comparing three techniques of conization: cold knife cone, laser and LEEP. Gynecol Oncol, 54, 175-9. https://doi.org/10.1006/gyno.1994.1189
  11. Miller NF, Todd OE (1938). Conization of the cervix. Surg Gyncol Obstet, 67, 265-70.
  12. Mitchell MF, Schottenfeld D, Tortolero-Luna G, et al (1998). Colposcopy for the diagnosis of squamous intraepithelial lesion: a meta analysis. Obstet Gynecol, 91, 626-31. https://doi.org/10.1016/S0029-7844(98)00006-4
  13. Moss EL, Dhar KK, Byrom J, Jones PW, Redman CW (2009). The diagnostic accuracy of colposcopy in previously treated cervical intraepithelial neoplasia. J Low Genit Tract Dis, 13, 5-9. https://doi.org/10.1097/LGT.0b013e31817f36d4
  14. Oyesanya OA, Amerazinghe C, Manning EA (1993). A comparison between loop diathermy conization and coldknife conization for management of cervical dysplasia associated with unsatisfactory colposcopy. Gyneol Oncol, 50, 84-8.
  15. Paraskevaidis E, Lolis ED, Koliopoulos G, et al (2000). Cervical intraepithelial neoplasia outcomes after large loop excision with clear margins. Obstet Gynecol, 95, 828-31. https://doi.org/10.1016/S0029-7844(00)00791-2
  16. Raio L, Ghezzi F, Di Naro E, et al (1997). Duration of pregnancy after carbon dioxide laser conization of the cervix: influence of cone height. Obstet Gynecol, 90, 978-82. https://doi.org/10.1016/S0029-7844(97)00489-4
  17. Sadler L, Saftlas A, Wang W, et al (2004). Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA, 291, 2100-6. https://doi.org/10.1001/jama.291.17.2100
  18. Sagot P, Caroit Y, Winer et al (1995). Obstetrical prognosis for carbon dioxide laser conisation of the uterine cervix. Eur J Obstet Gynecol Reprod Biol, 58, 53-8. https://doi.org/10.1016/0028-2243(94)01986-H
  19. Sjoborg KD, Vistad I, Myhr SS, et al (2007). Pregnancy outcome after cervical cone excision: a case control study. Acta obstet Gynecol, 86, 423-8. https://doi.org/10.1080/11038120701208158
  20. Skjeldestad FE, Hagen B, Lie AK, Isaksen C (1997). Residual and recurrent disease after laser conization for cervical intraepithelial neoplasia. Obstet Gynecol, 90, 428-33. https://doi.org/10.1016/S0029-7844(97)00276-7
  21. Ueda M, Ueki K, Kanemura M, et al (2006). Diagnostic and therapeutic laser conization for cervical intraepithelial neoplasia. Gynecol Oncol, 101, 143-6. https://doi.org/10.1016/j.ygyno.2005.10.001
  22. Ueki M, Okamoto Y, Misaki O, et al (1994). Conservative therapy for microinvasive carcinoma of the uterine cervix. Gynecol Oncol, 53, 109-13. https://doi.org/10.1006/gyno.1994.1096
  23. Wuntakal R, Castanon A, Sasieni PD, Hollingworth A (2013). Pregnancy outcomes after treatment for cervical intraepithelial neoplasia in a Single NHS Hospital. Int J Gynecol Cancer, 23, 710-5. https://doi.org/10.1097/IGC.0b013e3182885496