CERVICAL INTRAEPITHELIAL NEOPLASIA TREATMENT. ANALYSIS OF THE DATA OF THE PATIENTS TREATED AT DEPARTMENT OF GYNECOLOGY AND OBSTETRICS IN LJUBLJANA DURING 1996–2000
Abstract
Background. Successful diagnosis and management of cervical intraepithelial neoplasia (CIN) prevent the occurrence of invasive cervical cancer, which is one of the important indicators of the national health care.
Methods. The retrospective analysis studies patients at Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, who had in the period from January 1996 to December 2000 cervical biopsy due to CIN suspicion, based on abnormal PAP smear test and/or abnormal colposcopy. The patients, whose CIN diagnosis was confirmed with cervical biopsy sample histology, were treated by local methods (laser vaporisation, laser conization, large loop excision of the transformation zone (LLETZ), cold-knife conization), hysterectomy or just supervised with 4–6 month PAP smear and colposcopy follow-up. Our efficiency criteria were PAP smear one year after the treatment and excised tissue histology (for local excision methods and hysterectomy). We also compared the histology of the cervical biopsy sample and the excised tissue after excision methods of treatment and hysterectomy. The sources of our database were the patients’ records.
Results. The study analyses 800 patients. In 195 women (24%) CIN wasn’t confirmed by cervical biopsy sample histology. In the remaining 605 patients (76%), we diagnosed severe dysplasia (CIN III) in 332 women (55%), moderate dysplasia (CIN II) in 153 women (25%) and light dysplasia (CIN I) in 120 women (20%). CIN was most frequently diagnosed in the age between 30 and 34. CIN III was most frequently treated with cold-knife conization and CIN II with laser vaporisation. We also treated 120 patients (66%) with CIN I, mostly with laser vaporisation. There were no substantive differences in therapeutic efficacy between the methods of treatment. Besides hysterectomy, the most successful method was cold-knife conization in 96,9%, and the least successful LLETZ in 91,7%. The histology between cervical biopsy sample and excised tissue after local excision methods and hysterectomy matched in 75%.
Conclusions. Considering known criteria we find local conservative methods of CIN treatment successful and having advantage compared to the other methods of CIN treatment.
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References
Cancer Registry of Slovenia. Annual Reports, 1997, 1999, 2000. Ljubljana: Onkološki inštitut, 1997, 1999, 2000.
Možina A. Zgodnja detekcija raka materničnega vratu, kolposkopski tečaj. Zbornik predavanj. Ljubljana: SPS Ginekološka klinika Ljubljana, 2002.
Dey P, Gibbs A, Arnold DF, Saleh N, Hirsch PJ, Woodman CB. Loop diaterhermy excision compared with cervical laser vaporisation for the treatment of intraepithelial neoplasia: a randomised controlled trial. BJOG 2002; 109: 381–5.
Reich O, Lahousen M, Pickel H, Tamussino K, Winter R. Cervical intraepithelial neoplasiaIII; long term follow-up after cold-knife conisation with involved margins. Obstet Gynecol 2002; 99: 193–6.
Cirisano FD. Management of pre-invasive disease ot the cervix. Semin Surg Oncol 1999; 16: 222–7.
Boulanger JC, Gondry J, Verhoest P, Capsie C, Najas S. Treatment of CIN after menopause. Eur J Obstet Gynecol Repord Biol 2001; 95: 175–80
Gornall RJ, Boyd IE, Manolitsas T, Herbert A. Interval cervical cancer following treatment for cervical intraepithelial neoplasia. Int J Gynecol Cancer 2000; 10: 198–202.
Berek JS. Novak‘s gynekology. 12th edition. Baltimore: Williams and Wilkins, 1996.
Di Roma E, Parlavecchio E, Vetraino G, Corosu R. CIN: multicentric study of terapevtic strategiea. Minerva Ginecol 2001; 53: 379–2.
Costa S, De NuzzoM, Infante FE, Bonavita B, Marinelli m. Disease persistence in patients with cervical intraepithelial neoplasia undergoing electrosurgical conisation. Gynecol Oncol 2002; 85: 119–24.
Paraskevaidis E, Koliopoulos G, Malamou-Mitsi V, Zikopoulos K, Loli DE. Large loop excision of the transformation zone for treating cervical intraepithelial neoplasia: a 12-year experience. Anticancer Res 2001; 21: 3097–9.
Bretelle F, Cravello L, Yang L, Benmoura D, Roger V, Blanc B. Conisation with positive margins: what strategy should be adopted? Ann Chir 2000; 125: 444–9.
Nafussi A, Rebello G, al-Yusif R, McGoogan E. The borderline cervical smear: colposcopic and biopsy outcome. J Clin Pathol 2000; 53: 439–44.
Hillemanns P, Kimmig R, Dannecker C, Noorzai T, Diebold J, Thaler CJ, Hepp H. LEEP versus cold knife conisation for treatment of cervical intraepithelial neoplasias. Zentralbl Gynakol 2000; 122: 35–42.
Snoek R, Noel JC, Muller C, De ClercQ E, Bossens M. Cidofovir, a new approach for the treatment of cervix intraepithelial neoplasia grade III (CIN III). J Med Virol 2000; 60: 205–9.
Howells RE, O‘Mahony F, Tucker H, Millinship J. How can the incidence of negative specimens resulting from LLETZ be reduced? BJOG 2000; 107: 1075–82.
Ioffe OB, Brooks SE, De Rezende RB, Silverberg SG. Artifact in cervical LLETZ specimens: correlation with follow-up. Int J Gynecol Pathol 1999; 18: 115–21.
Das SS, Elias AH. Diagnosis and treatment of cervical intraepithelial neoplasia in a single visit. Aust N Z J Obstet Gynaecol 1998; 38: 256–50.
Kralj B, Denona V. 2. kongres ginekologov in porodničarjev Slovenije z mednarodno udeležbo, Portorož, 2000. Zbornik. Ljubljana: Združenje ginekologov in porodničarjev Slovenije, 2000.
Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. 2001 Consensus Guidelines for management of women with cervical cytological abnormalities. JAMA 2002; 287: 2120–9.
GLOBOCAN 2000. Cancer incidence, mortality and prevalence worldwide, Version 1,0. IARC Cancer Base No. 5.
Pradhan P, Andrews JD. Carbon dioxide laser therapy of cervical intraepithelial neoplasia. Journal of the Institute of Medicine 1999; 21: 1–45.
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