cervical conization


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Cervical Conization

 

Definition

Cervical conization is both a diagnostic and treatment tool used to detect and treat abnormalities of the cervix. It is also known as a cone biopsy or cold knife cone biopsy.

Purpose

Cervical conization is performed if the results of a cervical biopsy have found a precancerous condition in the cervix. The cervix is the small cylindrical organ at the lower part of the uterus, which separates the uterus from the vagina. Cervical conization also may be performed if there is an abnormal cervical smear test (Pap test). A biopsy is a diagnostic test in which tissue or cells are removed from the body and examined under a microscope, primarily to look for cancer or other abnormalities.

Precautions

As with any operation that is performed under general anesthesia, the patient must not eat or drink anything for six to eight hours before surgery.

Description

The patient lies on the table with her legs raised in stirrups, similar to the position when having a Pap test. The patient is given general anesthesia, and the vagina is held open with an instrument called a speculum. Using a scalpel or laser the doctor removes a cone-shaped piece of the cervix containing the area with abnormal cells. The resulting crater is repaired by stitching flaps of tissue over the wound. Alternatively, the wound may be left open, and heat or freezing is used to stop bleeding.
Once the tissue has been removed, it is examined under a microscope for signs of cancer. If cancer is present, other tests will be needed. Surgery will be performed to remove the cervix and uterus (hysterectomy) and other treatments may be used as well. If the abnormal cells are precancerous, a laser can be used to destroy them.
Cold knife cone biopsy used to be the preferred treatment for removing abnormal cells in the cervix. Now, most cone biopsies are performed using laser surgery. Cold knife cone biopsy is generally used only for special situations. For example, if a biopsy did not remove all the abnormal cells, the cold knife cone procedure allows the physician to remove what's left.

Aftercare

An overnight stay in the hospital may be required. After the test, the patient may feel some cramps or discomfort for about a week. Women should not have sex, use tampons, or douche until after seeing their physician for a follow up appointment (a week or more after the procedure).

Risks

Because cone biopsies carry risks such as bleeding and problems with subsequent pregnancies, they have been replaced with newer technologies except in a few circumstances.
About one in 10 women experience bleeding from the vagina about two weeks after the biopsy. There is also a slight risk of infection or perforation of the uterus. In a few women, the cervical canal becomes narrowed or completely blocked, which can later interfere with the movement of sperm. This can impair a woman's fertility.
If too much muscle tissue has been removed, the procedure can lead to an incompetent cervix, which can be a problem with subsequent pregnancies. An incompetent cervix cannot seal properly to maintain a pregnancy. If untreated, the condition increases the odds of miscarriage or premature labor.
Cervical conization also may temporarily alter cervical cells, which can make a Pap smear test hard to interpret accurately for three or four months.

Normal results

This procedure is only performed if an abnormality is known or suspected.

Abnormal results

The presence of precancerous or cancerous cells in the cervix.

Resources

Organizations

Cancer Information Service. 9000 Rockville Pike, Building 31, Suite 10A18, Bethesda, MD 20892. 1-800-4-CANCER. http://wwwicic.nci.nih.gov.

Key terms

Biopsy — The removal of a small piece of living tissue for examination under a microscope.
Pap test — The short term for Papanicolaou test, this procedure tests a smear of cellular material scraped from the cervix and examined under a microscope to detect abnormal cells.

cervical conization

the excision of a cone-shaped tissue section from the endocervix, performed to obtain a tissue sample to establish a precise diagnosis. It may be performed under general anesthesia (cold knife cone) or as an in-office procedure (loop electrosurgical excision procedure). See also cone biopsy.

cervical conization

See Conization.
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References in periodicals archive ?
Randomized trial results indicate that a vasopressin dose of 4 U is effective in reducing blood loss during second trimester pregnancy termination, (7) and a dose of 3 U is effective in reducing blood loss during cervical conization.
This policy of post-treatment cytological surveillance ensures early detection of treatment failure and repeat conservative treatment as necessary for those who have a preserved uterus with cervical conization.
Mary went to a new OB/GYN, who concluded that she probably wasn't able to become pregnant because of the cervical conization procedure.
Himes, of the department of obstetrics and gynecology, Magee--Womens Hospital, Pittsburgh, identified 1,080 women who had become pregnant after undergoing a colposcopic biopsy, a loop electrosurgical excision procedure, or a cold knife cone biopsy Overall, cervical conization was not associated with an increased rate of preterm birth, which occurred in 12.
The procedure can be performed in the office setting without the use of local or general anesthesia, making it superior to the more invasive procedures performed before the availability of cryotherapy (eg, cervical conization and hysterectomy).
Time from cervical conization to pregnancy and preterm birth.
Women who had undergone cervical conization and/or hysterectomy were excluded.
A patient with an HSIL+ Pap test result but a negative cervical biopsy finding is usually scheduled for a loop electrocautery excisional procedure or cervical conization, which could be avoided if the Pap test result was reinterpreted as NILM.
Moreover, sample quality was similar for both methods when compared with pathology results in 41 patients who underwent cervical conization, she reported.
Because AIS may be multifocal, small, or secluded in the endocervical canal, cervical conization is generally recommended to confirm the diagnosis, exclude an occult invasive adenocarcinoma, and serve as possible therapy.
All diagnoses of SCC in this study were established by histopathologic examinations, including endocervical curettage, cervical biopsy, and/or diagnostic excisional procedures by loop electrosurgical excision procedures or cold knife cervical conization.
Histopathologic follow-up included endocervical curettage, cervical biopsy, cervical conization by loop electrosurgical excision procedure, or cold knife conization.