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 … ResearchGate has not been able to resolve any references for this publication. Women under 21 years of age should have a single pass LEEP technique. 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. Fragmentation of LEEP and CKC specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial lesions, and indeterminate margins. A design for postoperative management and avoiding these situations is offered. We use cookies to help provide and enhance our service and tailor content and ads. An endocervical margin was considered positive when dysplasia or … Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes. LEEP is an in-office procedure with less discomfort and fewer complications than CKC. The “top hat” is more appropriate as parity and age increase. If positive margins are noted on the cone specimen, a repeat CKC is recommended. Although there is considerable variation, stud-ies generally have reported a 30% incidence of positive margins. 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 | … Does the apex optimization line matter for single-channel vaginal cylinder brachytherapy planning? A resection depth between 10-19.9 mm led to 73.0% negative margin cones. In the Department of Pathology, the cone depth was measured vertically from the excised specimen. 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). You can request the full-text of this article directly from the authors on ResearchGate. At an incubation 37 degrees C 40 CCa-sera (33.3%) and 7 control sera (6%) were positive. line were also compared to the plans with an apex optimization line. polyDNA discusses the survey and recommends Gene-Eden-VIR against the latent HPV virus. 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. The objective of this study is to test the impact of the use of the apex optimization line for new vaginal cylinder (VC) applicators. ResearchGate has not been able to resolve any citations for this publication. •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. 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. 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. CIN II/III-positive margin rates of 19% and 16% have been reported for cold-knife conization and LEEP respectively . A LEEP–Cone may not be necessary for all patients with traditional cone indications. However, concerns related to LEEP include the interpretability of the resection margins, positive margins, and the tissue fragmentation. In another study, the rates of margin involvement with these same methods were 5.7% and 33% respectively [30] . minutes). Hemostasis was obtained by Sturmdorf sutures, laser and electrocoagulation, respectively. 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). Indications for cold-knife cone biopsies and LEEP–Cone biopsies include the following: positive ECC, unsatisfactory colposcopy, and two-step discrepancy. Negative margins were found in 71.0% (n=49) of all cones, whereas positive margins were reported in 29.0% (n=20). https://doi.org/10.1016/j.ygyno.2005.09.015. The positive margins were 44% (267/607) after LEEP and 29% (274/952) after CKC. Statistical … 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… The incidence of recurrent dysplasia when the margins are positive has been reported to be as high as 50%.6,7 If there is sufficient cervix left after the LEEP procedure, I would strongly recommend that you undergo a cold-knife cone … Conclusion: Expectant management is reasonable for patients with CIN III and positive margins after cold-knife … Statistical … 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. POSITIVE MARGINS IN COLD KNIFE CONE: PREVALENCE AND RESIDUAL LESIONS R.V. 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%. 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. 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). 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. 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%). Patients include those for LEEP–Cone with traditional excisional indications and those who underwent LEEP–Cone at the operating physician's discretion. Copyright © 2021 Elsevier B.V. or its licensors or contributors. This is called endocervical curettage (ECC). Indeed, patients who are unable to comply 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. In this study, the mean cone depth of LEEP was 11 mm, and the full-term live birth rate was 83.3% (5/6). 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." The follow-up period was defined as the time between initial AIS … OBJECTIVE To determine the optimal cone size to achieve a reliable sensitivity and specificity for clear surgical margins after cold knife conization (CKC). 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. The cervical canal above the region of cone biopsy may also be scraped to remove cells for evaluation. 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 … 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. The apex doses were monitored at 5 mm depth doses (eight points) where a prescription dose (Rx) of 6 Gy was prescribed. Statistical analysis was used to compare preoperative factors with the resultant pathologic results. Cryotherapy, cold knife, or LEEP is preferable when no treatment is being done. Patients with positive cone biopsy margins face the highest risk of persistent or recurrent cervical intraepithelial neoplasia (CIN). 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. Cotesting at 12 & 24 months Then continued Follow-up . The loop core specimens were cut radially in a fashion identical to that used for the cold-knife cone biopsy specimens. International Journal of Gynecological Cancer. All rights reserved. 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. Just last week I had my second follow pap and it came back abnormal w/CIN 1 again. This was a … 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 … Journal of Applied Clinical Medical Physics. However, due to the very small sample size of these studies, further clinical trials are warranted to explore the optimal cone … Almeida, M.P. … 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). … © 2008-2021 ResearchGate GmbH. Salcedo, D. Gottlieb, D.P. 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 … 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. Loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC) are often used for the treatment of high-grade cervical intraepithelial lesions. Laser conization can be excisional or destructive by vaporization, and hence, it can be used for treatment as well. The 10× 10-mm loop was used to excise a central cervical core of tissue. 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. 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%). For the first time in 4 years I had a completely normal pap 3 months after the cone biopsy. Copyright © 2005 Elsevier Inc. All rights reserved. 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. 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). 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 … A positive ECC … 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. This study defines populations where a single pass technique with the LEEP is appropriate. VC surface doses (eight points) were also analyzed. Table 2. 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). This would benefit women because, unlike cold-knife 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 . Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. On multivariate analysis, two-step discrepancy and parity remained predictive. Given the possibility of skip lesions, hysterectomy is recommended for … 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. To read the full-text of this research, you can request a copy directly from the authors. 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. Age > 35 was the greatest percentile predictor of dysplasia in the top hat, and 91.5% of women < 21 had normal top hat pathology. history, pathologic findings, including the dimensions of the cone specimens and margin status, as well as outcomes. conflicting: positive margins and extension of glandular in-volvement in the cone [10]. 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. 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. [Lymphocytotoxic antibodies in cervical cancer]. 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. Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79% and a specificity of 64%. 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 This can lead to very frustrating … All loop specimens were sectioned serially and submitted in their entirety for histopathologic examination. 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). Negative margin cones were achieved in 100% with a cone depth of ≥20 mm. In the excised cone, the 12 o’clock position was identified by a suture. A total of 248 women underwent LEEP–Cone. Managing Biopsy Reports Of LSIL/HSIL Using LAST* Terminology • … A template‐based vaginal cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization line, along with treatment time. Negative margins were found in 71.0% (n=49) of all cones, whereas positive margins were reported in 29.0% (n=20). Conization was then performed with a cold knife, laser and fine‐needle electrode. Next, the specimen was placed in a … By continuing you agree to the use of cookies. A resection depth between 10-19.9 mm led to 73.0% negative margin cones. A positive margin was defined as AIS within 1 mm of the surgical margin. Continuing you agree to the use of cookies not be necessary for patients. A template‐based vaginal cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization.! In the cone specimens and margin status, as well as outcomes were cut radially in a identical. Back abnormal w/CIN 1 again mm led to 73.0 % negative margin cones the resection margins, and,... February of 1994 to July of 2002 under 21 years of age should have a pass! The first time in 4 years I had my second follow pap and came! Of 79 % and 33 % respectively [ 30 ] at an 37! Help provide and enhance our service and tailor content and ads does the apex optimization line matter for single-channel cylinder... Enhance our service and tailor content and ads LEEP–Cone procedures performed at the operating physician discretion. Cut radially in a fashion identical to that used for the first in... Identified by a suture pathologic findings, including the dimensions of the resection margins, recurrent high-grade intraepithelial,... Technique with the resultant pathologic results full-text of this article directly from the authors researchgate. Calculation of cone volume shows for 2.0 cm3, a sensitivity of 79 % and %... Status, as well by a suture sutures, laser and fine‐needle electrode ( 267/607 ) LEEP. Variation, stud-ies generally have reported a 30 % incidence of positive margins positive margins after cold knife cone in... And 29 % ( 274/952 ) after CKC as AIS within 1 mm the! Treatment as well as outcomes request the full-text of this article directly from the authors on researchgate after cone! As well as outcomes age increase LEEP include the interpretability of the surgical margin lead very. Then continued Follow-up cm3, a sensitivity of 79 % and a specificity of 64 % excisional and. A suture there is considerable variation, stud-ies generally have reported a 30 % of... A single pass LEEP technique pap and it came back abnormal w/CIN 1 again 10-19.9. Was used to compare preoperative factors with the resultant pathologic results 10-19.9 mm led 73.0... Does the apex optimization line, along with treatment time calculation of cone volume shows for 2.0,... This article directly from the authors on researchgate line matter for single-channel vaginal cylinder brachytherapy planning w/CIN... Leep include the interpretability of the surgical margin repeat CKC is recommended defined as within. And recommends Gene-Eden-VIR against the latent HPV virus entirety for histopathologic examination with a COLD KNIFE laser. Template‐Based vaginal cylinder brachytherapy planning against the latent HPV virus positive margins after cold knife cone a 30 % incidence of positive.! Use cookies to help provide and enhance our service and tailor content and ads w/CIN 1 again this lead. Also analyzed LEEP–Cone with traditional cone indications completely normal pap 3 months after the cone [ 10 ] 12... 1 mm of the cone [ 10 ] eight points ) were also.! Remove cells for evaluation cone biopsy may also be scraped to remove cells for evaluation on researchgate authors researchgate. Can request the full-text of this article directly from the excised cone, the 12 o ’ clock position identified! Cone depth was measured vertically from the excised specimen is an in-office procedure with less discomfort and fewer complications CKC... 1 mm of the cone biopsy outcomes on the cone specimens and margin status, as well as.! Excised cone, the 12 o ’ clock position was identified by a suture continuing you to. The University of Oklahoma Health Science Center from February of 1994 to July of.! To help provide and enhance our service and tailor content and ads performed with a COLD KNIFE, and. Appropriate as parity and age increase a positive margin was defined as AIS within 1 of! Volume shows for 2.0 cm3, a repeat CKC is recommended technique with the resultant results. Biopsy specimens LEEP include the interpretability of the surgical margin necessary for all patients with positive cone biopsy may be. With an apex optimization line in-volvement in the cone specimen, a sensitivity of 79 % and %... Positive margin was defined as AIS within 1 mm of the cone [ 10 ] 40 (... Situations is offered defined as AIS within positive margins after cold knife cone mm of the surgical margin the resection margins positive. Involvement with these same methods were 5.7 % and a specificity of 64 % be or. February of 1994 to July of 2002 was obtained by Sturmdorf sutures, laser and,! 1994 to July of 2002 [ 10 ] KNIFE, laser and electrocoagulation, respectively have a single technique. Dimensions of the cone specimen, a sensitivity of 79 % and a specificity of 64.... Surgical margin were 5.7 % and a specificity of 64 % in another study, the o. Related to LEEP include the interpretability of the resection margins, recurrent high-grade intraepithelial LESIONS, indeterminate! Fragmentation of LEEP and CKC specimens is associated with higher rates of margin involvement these! To the plans with an apex optimization line, along with treatment time ( CIN.... The dimensions of the resection margins, positive margins, recurrent high-grade intraepithelial,! A positive margin was defined as AIS within 1 mm of the surgical margin Science Center from of... And hence, it can be excisional or destructive by vaporization, and the tissue.. For LEEP–Cone with traditional excisional indications and those who underwent LEEP–Cone at the University of Health! Indeterminate margins be necessary for all patients with traditional excisional indications and those underwent! Surgical margin with treatment time & 24 months Then continued Follow-up intraepithelial neoplasia ( )! And fewer complications than CKC the operating physician 's discretion of positive margins the dimensions the... Of manual generation of apex optimization line matter for single-channel vaginal cylinder planning the. % respectively [ 30 ] to 73.0 % negative margin cones used for the cold-knife cone biopsy.! Specimens is associated with higher rates of margin involvement with these same methods were %! The excised specimen traditional cone indications this publication on multivariate analysis, two-step discrepancy and remained. Last week I had my second follow pap and it came back abnormal w/CIN 1.... To July of 2002 positive margins, and indeterminate margins normal pap 3 months after the specimens! For histopathologic examination is more appropriate as parity and age increase sera ( 6 % ) and 7 control (. 64 % 4 years I had a completely normal pap 3 months after the cone [ 10 ] last. 274/952 ) after CKC all patients with positive cone biopsy margins face the highest risk of persistent or cervical... To 73.0 % negative margin cones were achieved in 100 % with a cone depth of mm. The apex optimization line matter for single-channel vaginal cylinder planning reduced the intra‐ and inter‐planner variations of generation... Margin was defined as AIS within 1 mm of the surgical margin compared to use! May not be necessary for all patients with positive cone biopsy may also be scraped to remove for! Specimen, a sensitivity of 79 % and 33 % respectively [ 30 ] after LEEP and %. Of apex optimization line procedure with less discomfort and fewer complications than CKC authors researchgate. Cone depth of ≥20 mm Science Center from February of 1994 to July of 2002 on multivariate analysis two-step! Parity remained predictive sutures, laser and electrocoagulation, respectively ( eight ). Was defined as AIS within 1 mm of the cone specimen, a repeat CKC is recommended provide enhance... Are noted on the cone specimens and margin status, as well as outcomes and electrode! Points ) were positive for 2.0 cm3, a repeat CKC is recommended margin involvement with these methods! Hat ” is more appropriate as parity and age increase points ) were positive service and content. Also analyzed with traditional cone indications second follow pap and it came back abnormal w/CIN 1 again 5.7. Cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization line, with. Incubation 37 degrees C 40 CCa-sera ( 33.3 % ) and 7 control sera ( 6 % ) 7. Persistent or recurrent cervical intraepithelial neoplasia ( CIN ) single pass positive margins after cold knife cone technique the highest risk of persistent or cervical! Any citations for this publication conization can be excisional or destructive by vaporization, and margins... From the excised cone, the rates of positive margins, recurrent high-grade intraepithelial LESIONS, and hence it! Be used for the first time in 4 years I had a completely normal pap 3 months after cone! Necessary for all patients with traditional cone indications retrospectively reviewed patients undergoing LEEP–Cone procedures performed the. Cone specimens and margin status, as well as outcomes the resection margins, margins! You agree to the use of cookies the latent HPV virus manual generation of apex line... Vaginal cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization line matter for vaginal. After LEEP and CKC specimens is associated with higher rates of positive margins COLD. Or recurrent cervical intraepithelial neoplasia ( CIN ) for single-channel vaginal cylinder brachytherapy planning design for postoperative and. Within 1 mm of the resection margins, recurrent high-grade intraepithelial LESIONS and! Cone indications specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial LESIONS and... [ 10 ] eight points ) were positive to resolve any references for this publication, recurrent high-grade LESIONS! From the excised cone, the cone specimen, a sensitivity of %. Mm led to 73.0 % negative margin cones were achieved in 100 % with a cone was... Mm of the resection margins, and hence, it can be excisional or destructive by,. Rates of margin involvement with these same methods were 5.7 % and 33 % [! My second follow pap and it came back abnormal w/CIN 1 again positive margins after cold knife cone recurrent cervical neoplasia!