title: Margin clearance and HPV infection do not influence the cure rates of early neoplasia of the uterine cervix by laser conization.
abstract: A lesion existing in the endocervical and/or ectocervical conized margin and HPV-DNA existing in a conized specimen are reported to be at risk of persistence or recurrence of early neoplasia of the cervix when treated by conization. The aim of this study was to investigate whether margin clearance and HPV infection influenced the outcome in our series of laser conization. Excisional conization with the KTP/YAG Surgical Laser System or Nd-YAG laser was performed in this study. Eighty patients with cervical neoplasias were included: 47 with dysplasia, 25 with carcinoma in situ (CIS) and eight with microinvasive carcinoma. The endocervical and ectocervical conized margins were examined microscopically. HPV-DNA was analyzed with the primer for types 16, 18, 31, 33, 35, 52b and 58 amplified by the PCR method. The margins of the conized specimens were confirmed histopathologically to be clear in 58 cases (73%), whereas in 22 cases (27%) they were involved by neoplasia. HPV-DNA was positive in 38% of dysplasias, 40% of CISs and 50% of microinvasive carcinomas. The overall rate of the initial cure at 10 weeks after treatment appeared to be 100% in all 80 cases. Primary cure rates were 100% for 47 cases with dysplasia, 96% for 24 cases with CIS and 100% for four cases with microinvasive carcinoma regardless of margin positivity and HPV-DNA status. Involved margins and HPV infection did not influence the cure of early neoplasia of the uterine cervix achieved by our laser conization procedure. The favorable results may be due to the procedure of vaporizing the cut surface forming a dome-shaped tissue defect.
authors.affiliation: Department of Obstetrics and Gynecology, The Kitasato Institute Medical Center Hospital, Kitasato University, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Izumi
authors.forename: N
authors.initials: N
authors.lastname: Kyushima
authors.forename: T
authors.initials: T
authors.lastname: Genda
authors.forename: N
authors.initials: N
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Kanai
authors.forename: K
authors.initials: K
authors.lastname: Wakita
authors.forename: H
authors.initials: H
authors.lastname: Kuramoto
mesh_terms: D019092:Conization; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D053685:Laser Therapy; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications*; D014412:Tumor Virus Infections / Q000150:complications*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology
chemical_list: D004279:DNA, Viral