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Conservative treatment of cervical intraepithelial neoplasia using a cold-knife section technique
Chafika Mazouni1, Geraldine Porcu, Olivier Haddad
1Department of Oncologic Gynecology, Marseille Public Hospital System (APHM), Hôpital de la Conception, Service de Gynécologie A, Marseille, France. kodama@cc.okayama-u.ac.jp
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.
Design:
Prospective study.
Setting:
Gynecological Oncology Department in French Public Hospital.
Population:
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.
Main Outcome Measures:
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.
