title: Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes.
abstract: OBJECTIVE
  To assess how the proportion of the cervical volume/length removed during treatment for cervical intraepithelial neoplasia (CIN) varies and whether this correlates to the pregnancy duration at delivery.
  
  
  METHODS
  The present prospective observational study included 142 women undergoing CIN treatment at a university hospital during 2009-2013. The pretreatment and post-treatment cervical dimensions and cone size were measured with magnetic resonance imaging, three-dimensional transvaginal ultrasonography, or two-dimensional transvaginal ultrasonography, and the correlation between pregnancy outcomes and the relative proportion of the cervix excised was assessed.
  
  
  RESULTS
  Pretreatment cervical volumes and cone volumes varied substantially (range 11-40 cm(3) and 0.6-8 cm(3), respectively). The proportion of the volume excised ranged from 2.2% to 39.4%. Sixteen (11%) women conceived following treatment; 12 had a live birth (seven at term, three preterm). The pregnancy duration at delivery was significantly correlated with the proportion of the cervical volume (r=-0.9; P<0.001) and length (r=-0.7; P=0.01) excised and the cone volume (r=-0.6; P=0.04).
  
  
  CONCLUSIONS
  The pretreatment cervical dimensions and the proportions of the volume/length excised vary substantially, and the latter correlates with the pregnancy duration. Assessment of the proportion excised might help to stratify women at risk who need intensive surveillance when pregnant.
authors.affiliation: Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK; West London Gynecological Cancer Center, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK. Electronic address: m.kyrgiou@imperial.ac.uk.
authors.forename: Maria
authors.initials: M
authors.lastname: Kyrgiou
authors.affiliation: Department of Obstetrics and Gynecology-Gynecological Oncology, University Hospital of Ioannina, Ioannina, Greece; Department of Obstetrics and Gynaecology, Worthing Hospital, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK.
authors.forename: George
authors.initials: G
authors.lastname: Valasoulis
authors.affiliation: Department of Obstetrics and Gynecology-Gynecological Oncology, University Hospital of Ioannina, Ioannina, Greece; IVF Unit, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK.
authors.forename: Sofia-Melina
authors.initials: SM
authors.lastname: Stasinou
authors.affiliation: Department of Obstetrics and Gynecology-Gynecological Oncology, University Hospital of Ioannina, Ioannina, Greece; Northern Gynecological Oncology Center, QE Gateshead NHS Trust, Gateshead, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Founta
authors.affiliation: Department of Obstetrics and Gynecology-Gynecological Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Athanasiou
authors.affiliation: Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK; West London Gynecological Cancer Center, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, UK.
authors.forename: Phillip
authors.initials: P
authors.lastname: Bennett
authors.affiliation: Department of Obstetrics and Gynecology-Gynecological Oncology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Paraskevadis
mesh_terms: D000328:Adult; D005260:Female; D006785:Hospitals, University; D006801:Humans; D021621:Imaging, Three-Dimensional; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*
keywords: Cervical intraepithelial neoplasia (CIN); Large loop excision of the transformation zone (LLETZ); Loop electrosurgical excisional procedure (LEEP); Preterm birth; Ultrasonography