Conservative treatment of cervical intraepithelial neoplasia using a cold-knife section technique.
OBJECTIVE
The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of childbearing potential and extent of dysplasia.


METHODS
Prospective study.


METHODS
Gynecological Oncology Department in French Public Hospital.


METHODS
A total of 460 women treated for CIN between 1985 and 1999 were included.


METHODS
A conservative cold-knife cervical section followed by blanket suture reconstruction was used in all cases.


METHODS
Immediate operative results, recurrence and reproductive function were assessed.


RESULTS
The mean length of the cervical specimen was 11.4 mm (range, 4-22 mm). Mean specimen thickness was strongly correlated with age: 10.6 +/- 4.1 mm in women <40 years versus 12.1 in women >40 years; p < 0.001. Complete excision was achieved in 395 cases (85.8%). Post-operative bleeding was observed in 5 cases (1.1%). The mean duration of follow-up was 62 months (range, 12.3-156.5 months). Recurrences developed in 26 patients (6.6%) including CIN 1 in 9 cases, CIN 2 in 9 and CIN 3 in 8. No patient developed carcinoma. The actuarial risk of recurrence was 2.4% (+/- S.D., 0.9) at 24 months and 7.8% (+/-S.D., 1.9) at 60 months. A total of 52 pregnancies were observed in 39 patients. No case of de novo infertility was reported post-operatively. Amenorrhea was noted in 1 patient (0.1%) and dysmenorrhea in 1 patient (0.1%).


CONCLUSIONS
This conservative cold-knife section technique is effective for treatment of CIN with low morbidity and little adverse effect on childbearing potential. Exposure of the squamocolumnar junction (SCJ) greatly facilitates follow-up.
Mazouni
Chafika
C
Department of Oncologic Gynecology, Marseille Public Hospital System (APHM), Hôpital de la Conception, Service de Gynécologie A, Marseille, France. kodama@cc.okayama-u.ac.jp
Porcu
Geraldine
G
Haddad
Olivier
O
Dalès
Jean-Philippe
JP
Taranger-Charpin
Colette
C
Piana
Lucien
L
Bonnier
Pascal
P
D000328:Adult; D003127:Colposcopy / Q000379:methods; D019092:Conization / Q000295:instrumentation* / Q000379:methods; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*