Cervical conization
| Cervical conization | |
|---|---|
| ICD-9-CM | 67.2 |
Cervical conization refers to an excision of a cone-shaped portion of tissue from the mucous membrane of the cervix. Conization is used for diagnostic purposes as part of a biopsy and for therapeutic purposes to remove pre-cancerous cells (cervical intraepithelial neoplasia) or early stage cervical cancer.[1]
History
Prior to the introduction of the speculum, cervical cancer was only found once it was advanced. With the invention and use of a speculum, changes in the cervix could be appreciated. First, they were evaluated macroscopically and eventually were also assessed using a microscope. In 1927, H. Hinselmann discovered the transformation zone, where metaplastic squamous epithelium is found between the columnar epithelium of the endocervix and the squamous epithelium of the ectocervix. The transformation zone is clinically significant, as it is where almost all cervical cancers and precancerous lesions arise.[2]
All current cervical conization methods can be traced back to amputation of the ectocervix which was developed by Marion Sims in 1861. Prior to this, any excisions of cervical carcinomas were mainly a palliative care treatment option. A. Sturmdorf was the first to describe an excision of a cone shape from the ectocervix, however he utilized this as a treatment for cervicitis. J. E. Ayre was the first to introduce cold knife conization in 1948 and stressed the importance of evaluating the excised tissue in serial sections to assess the extent of invasion. This method of cold knife conization has been utilized and eventually options for excisions using electrocautery were developed as well. Initially, excised tissue utilizing electrocuatery was not satisfactory for evaluation, but as the loops used have become finer, the quality of the surgical specimens have improved to rival those of cold knife conization. Presently, electrocuatery methods are often preferred to cold knife conization due to greater ease of procedure.[2]
Types
- Cold knife conization (CKC)
- Laser conization
- Loop electrical excision procedure (LEEP)
Side effects
Cervical conization effectively reduces the risk of cancer developing or spreading but it causes an increased risk of premature birth in future pregnancies.[3][4]
The chances of cancer recurrence and premature birth depends on the type of conization. Cold knife conization is associated with 7% chance of the cancer recurring and 16% chance of premature birth, laser conisation comes with 6% cancer recurrence and 13% premature birth, and loop excision comes with 10% recurrence and 11% premature birth.[3][4]
See also
References
- ^ Cooper DB, Carugno J, Menefee GW (2023), "Conization of Cervix", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28722875, retrieved 2023-11-16
- ^ a b Reich O, Pickel H (December 2020). "200 years of diagnosis and treatment of cervical precancer". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 255: 165–171. doi:10.1016/j.ejogrb.2020.10.037. PMID 33137608.
- ^ a b c Athanasiou A, Veroniki AA, Efthimiou O, Kalliala I, Naci H, Bowden S, et al. (August 2022). "Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis". The Lancet. Oncology. 23 (8): 1097–1108. doi:10.1016/S1470-2045(22)00334-5. PMC 9630146. PMID 35835138.
- ^ a b c "Prevention of cervical cancer: what are the risks and benefits of different treatments?". NIHR Evidence (Plain English summary). U.K.: National Institute for Health and Care Research. 2023-11-10. doi:10.3310/nihrevidence_60599. S2CID 265201829.
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