II. Procedures: Diagnostic Excision
- Indications
- Colposcopy with CIN 2 or 3 on biopsy
- Persistent CIN 1 (for at least 2 years)
- Unsatisfactory Colposcopy with CIN Pap Smear
- Techniques: LEEP
- Office based procedure under Local Anesthesia
- Increased risk of Preterm Labor and low birth weight (but not extreme prematurity as with Cold Knife Conization)
- Post-LEEP cervical stenosis risk (if excessive cautery of crater rim)
- Cautery artifact occurs at excision margins (does not occur with Cold Knife Conization)
- LEEP histology has a high False Negative Rate
- Follow all dysplasia closely regardless of histology
- Livasy (2004) Obstet Gynecol 104:250-4 [PubMed]
- Post-procedure bleeding
- Perform LEEP procedure during Follicular Phase
- Luteal Phase associated with heavy bleeding
- Paraskevaidis (2002) Obstet Gynecol 99:997-1000 [PubMed]
- Techniques: Cold-knife conization
- Preferred if margin status is critical to determining residual disease (e.g. adenocarcinoma in situ)
- Increased adverse effects over LEEP
- Increased risk of extreme Preterm Labor and delivery (<28 weeks) at low birth weights (<2 kg)
- Higher risk of bleeding than LEEP
- Removes more tissue than LEEP
III. Procedures: Ablation
- Indications
- Contraindications
- Unsatisfactory Colposcopy (Invasive cancer not ruled out)
- Entire lesion not visualized
- Abnormal endocervical curettage
- Lesion larger than 2 quadrants
- Acceptable Techniques of ablation
- Cryotherapy
- Electrofulguration
- Laser ablation
- Cold Coagulation
- Unacceptable Techniques
- Podophyllin or similar products
- Advantages
- Similar outcomes when compared with LEEP and conization as long as adequate Colposcopy and no contraindications
- Removes less tissue than excisional techniques
- Cryotherapy and laser ablation have no increased risk of Preterm Labor
- Laser conization associated with Preterm Labor risk if conization depth >10 mm
- Disadvantages
- No tissue available for histology
IV. Management: Post-procedure surveillance
- Excisional techniques with positive margins for CIN 2-3
- Repeat Colposcopy with biopsy and ECC at 4-6 months
- If positive at that time, re-treat, re-excise or offer Hysterectomy
- Excisional technique with negative margins (or post-ablation)
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Related Studies
Definition (NCI) | Uses a thin, low-voltage electrified wire loop to cut out a thin layer of abnormal tissue; generally used to remove abnormal cells on the surface of the cervix. |
Definition (NCI_NCI-GLOSS) | A technique that uses electric current passed through a thin wire loop to remove abnormal tissue. |
Concepts | Therapeutic or Preventive Procedure (T061) |
SnomedCT | 36899001 |
Italian | Procedura di escissione mediante cauterizzazione |
English | Loop Electrosurgical Excision, Loop Electrosurgical Excision Procedure, loop electrosurgical excision procedure (LEEP), leep, loop excision, loop electrosurgical excision procedure, LEEP, Loop electrosurgical excision procedure, Loop electrosurgical excision procedure (procedure), Loop electrosurgical excision procedure, NOS |
Japanese | ループ式電気焼灼切除法, ループシキデンシショウシャクセツジョホウ |
Spanish | Procedimiento de escisión electroquirúrgia de asa, procedimiento de resección electroquirúrgica con asa, LEEP, procedimiento de escisión electroquirúrgica con asa (procedimiento), procedimiento de escisión electroquirúrgica con asa, procedimiento de resección electroquirúrgica con asa (procedimiento) |
Czech | Resekce elektrokauterizační kličkou |
Hungarian | Elektromos kacs excisiós beavatkozás |
Portuguese | Procedimento electrocirúrgico de remoção de alsa |
Dutch | elektrochirurgische lusexcisieverrichting |
French | Technique d'excision électrochirurgicale à l'anse |
German | elektrochirurgisches Exzisionsverfahren mit Schlinge |
Ontology: Conization (C0195324)
Definition (NCI) | Surgical removal of a cone-shaped portion of tissue from the uterine cervix. |
Definition (NCI_NCI-GLOSS) | Surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal. Conization may be used to diagnose or treat a cervical condition. |
Definition (MSH) | The excision of a cone of tissue, especially of the CERVIX UTERI. |
Concepts | Diagnostic Procedure (T060) |
MSH | D019092 |
ICD9 | 67.2 |
ICD10 | 35618-00 |
SnomedCT | 265891003, 149857000, 268415001, 142453006, 54535009, 110469002 |
English | Conisation, Conisations, Conizations, Conization, cone biopsy of cervix, cervical conization (treatment), cervical conization, Cervical cone biopsy, cervix conization, conization of cervix, cold knife cone biopsy, biopsy cone, cone biopsy, biopsy cold cone knife, biopsy cervical cone, cervical cone biopsy, conisation, cone biopsy cervix, conization cervical, Cervical conization, Conisation of cervix, Cervical conisation, conization, Conization of uterine cervix, Cone biopsy of cervix, Cone biopsy (procedure), Cone biopsy of cervix (procedure), Cone biopsy, Conisation of uterine cervix, Cone biopsy of cervix, NOS, Cone Biopsy of Cervix, Conization of Uterine Cervix, Conization of Cervix, Conization of cervix |
Italian | Conizzazione della cervice, Biopsia a cono cervicale, Conizzazione cervicale, Biopsia a cono della cervice, Conizzazione |
Dutch | baarmoederhals conus biopsie, conusbiopsie van cervix, cervicale conisatie, cervixconisatie, Conisatie |
French | Biopsie du cône du col utérin, Conisation du col utérin, Biopsie du cône cervical, Conisation cervicale, Conisation |
German | Portiokonisation Biopsie, Biopsie einer Portiokonisation, Zervixkonisation, Conisation, Konisation |
Portuguese | Conização do colo do útero, Biopsia cónica do colo do útero, Biopsia cónica cervical, Conização cervical, Conização |
Spanish | Biopsia en cono de cérvix, Biopsia cervical en cono, biopsia cónica (procedimiento), biopsia cónica del cuello del útero (procedimiento), biopsia cónica del cuello del útero, biopsia cónica, conización del cuello uterino, Conización cervical, Conización |
Japanese | 子宮頚部円錐切除, 子宮頚部円錐生検, シキュウケイブエンスイセイケン, シキュウケイブエンスイセツジョ, 円錐切除術, 円錐切除 |
Swedish | Konisering |
Czech | konizace, Konizace hrdla děložního, Konizace děložního čípku, Konizace hrdla, Konizace děložního hrdla, LEEP |
Finnish | Konisaatio |
Russian | BIOPSIIA KLINOVIDNAIA, KONIZATSIIA, БИОПСИЯ КЛИНОВИДНАЯ, КОНИЗАЦИЯ |
Polish | Wycięcie stożka szyjki macicy, Konizacja |
Hungarian | Méhnyak conisatio, Cervix cone biopszia, Cervicalis cone biopszia |
Norwegian | Konisering |
Croatian | Konizacija |