Clinicopathologic outcomes of laser conization for high-grade cervical dysplasia

To evaluate the incidence of thermal artifact and rates of persistent disease and recurrence in laser conization for cervical dysplasia.

A retrospective study examined the cases of 110 patients who underwent carbon dioxide laser conization for high-grade cervical dysplasia at our institution between January 1999 and March 2002. Rates of thermal artifact, persistent disease, recurrence, hemorrhage and cervical stenosis were investigated. Dysplasia severity and recurrence rates in smokers were also evaluated.

One hundred and five (95.5%) of 110 laser cones had negative margins, and only five (4.5%) had significant thermal artifact, with two (1.8%) noted to interfere with adequate evaluation of margins. Seventy-eight patients returned to Roswell Park Cancer Institute (RPCI) for follow-up with a mean follow-up period of 15.7 months. Fourteen (12.7%) patients had persistent disease detected within two visits, and one (0.9%) patient had a recurrence of dysplasia at ten months. One (0.9%) patient had same-day postoperative hemorrhage requiring hemostatic suturing. There were no cases of cervical stenosis detected at follow-up. Smokers had an increased incidence of high-grade lesions on cone biopsy when compared to non-smokers (46/57 and 30/53 patients, 80.7% and 56.7%, respectively; p = 0.008). The rate of persistent disease or recurrence was 8/57 (14%) in smokers and 7/53 (13.2%) in non-smokers (p = not significant).

Laser conization is an efficacious and safe procedure for the treatment of high-grade cervical dysplasia, with a very low incidence of thermal artifact and postoperative complications, and a relatively low rate of persistent disease. Smokers had a significantly increased incidence of high-grade lesions on cone biopsy.