Gynecology Book


Cervical Intraepithelial Neoplasia Procedures

Aka: Cervical Intraepithelial Neoplasia Procedures, CIN Management, Excisional Procedures for CIN Treatment, Ablative Procedures for CIN Teatment, Loop electrosurgical excision procedure, LEEP, Cervical Conization, Cervical Cone Biopsy, Cold Knife Conization
  1. See Also
    1. Colposcopy
    2. Cervix Anatomy
    3. Colposcopy Findings
    4. Colposcopy Protocol
    5. Cervical Dysplasia
    6. Cervical Cancer
    7. Atypical Squamous Cells of Undetermined Significance (ASCUS)
    8. Low Grade Squamous Intraepithelial Lesion (LSIL)
    9. High Grade Squamous Intraepithelial Lesion (HSIL)
    10. Atypical Glandular Cells of Undetermined Significance (AGUS Pap Smear)
    11. Human Papillomavirus (HPV)
  2. Procedures: Diagnostic Excision
    1. Indications
      1. Colposcopy with CIN 2 or 3 on biopsy
      2. Persistent CIN 1 (for at least 2 years)
      3. Unsatisfactory Colposcopy with CIN Pap Smear
    2. Techniques: LEEP
      1. Office based procedure under Local Anesthesia
      2. Increased risk of Preterm Labor and low birth weight (but not extreme prematurity as with Cold Knife Conization)
      3. Post-LEEP cervical stenosis risk (if excessive cautery of crater rim)
      4. Cautery artifact occurs at excision margins (does not occur with Cold Knife Conization)
        1. LEEP histology has a high False Negative Rate
        2. Follow all dysplasia closely regardless of histology
        3. Livasy (2004) Obstet Gynecol 104:250-4 [PubMed]
      5. Post-procedure bleeding
        1. Perform LEEP procedure during Follicular Phase
        2. Luteal Phase associated with heavy bleeding
        3. Paraskevaidis (2002) Obstet Gynecol 99:997-1000 [PubMed]
    3. Techniques: Cold-knife conization
      1. Preferred if margin status is critical to determining residual disease (e.g. adenocarcinoma in situ)
      2. Increased adverse effects over LEEP
        1. Increased risk of extreme Preterm Labor and delivery (<28 weeks) at low birth weights (<2 kg)
        2. Higher risk of bleeding than LEEP
        3. Removes more tissue than LEEP
  3. Procedures: Ablation
    1. Indications
      1. Colposcopy with CIN 2 or 3 on biopsy (HGSIL)
        1. Not recommended for recurrent lesions (excision is recommended)
      2. Persistent CIN 1 (LGSIL) for more than 2 years
        1. Not recommended for initial finding of CIN 1 (initial observation is preferred)
    2. Contraindications
      1. Unsatisfactory Colposcopy (Invasive cancer not ruled out)
      2. Entire lesion not visualized
      3. Abnormal endocervical curettage
      4. Lesion larger than 2 quadrants
    3. Acceptable Techniques of ablation
      1. Cryotherapy
      2. Electrofulguration
      3. Laser ablation
      4. Cold Coagulation
    4. Unacceptable Techniques
      1. Podophyllin or similar products
    5. Advantages
      1. Similar outcomes when compared with LEEP and conization as long as adequate Colposcopy and no contraindications
      2. Removes less tissue than excisional techniques
        1. Cryotherapy and laser ablation have no increased risk of Preterm Labor
        2. Laser conization associated with Preterm Labor risk if conization depth >10 mm
    6. Disadvantages
      1. No tissue available for histology
  4. Management: Post-procedure surveillance
    1. Excisional techniques with positive margins for CIN 2-3
      1. Repeat Colposcopy with biopsy and ECC at 4-6 months
      2. If positive at that time, re-treat, re-excise or offer Hysterectomy
    2. Excisional technique with negative margins (or post-ablation)
      1. See specific protocols for (CIN 1, CIN 2 and CIN 3, as well as ASC-US, ASC-H, ASGUS)
  5. References
    1. Apgar (2013) Am Fam Physician 87(12): 836-43 [PubMed]
    2. Burness (2020) Am Fam Physician 102(1): 39-48 [PubMed]
    3. Massad (2013) J Low Genit Tract Dis 17(5 suppl 1):S1-S27 [PubMed]
    4. Wright (2003) Am J Obstet Gynecol 189:295-304 [PubMed]

Loop electrosurgical excision procedure (C0184930)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Polish Wycięcie stożka szyjki macicy, Konizacja
Hungarian Méhnyak conisatio, Cervix cone biopszia, Cervicalis cone biopszia
Norwegian Konisering
Croatian Konizacija
Derived from the NIH UMLS (Unified Medical Language System)

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