Results: Mean depth of conization was 15.94 mm for cold knife conization and 10.08 mm for loop electrosurgical conization. Fifteen patients were excluded (5 with invasive cancer and 10 were lost to follow-up). This study included 55 patients with a mean 12-month follow-up. Six underwent hysterectomy for mini-invasion on the specimen or advanced age. Eleven underwent a second conization (followed by hysterectomy in 2 cases). The other 38 patients were submitted to simple surveillance with cervico-vaginal cytology and colposcopic examination. The rate of residual lesions (cervical intra-epithelial neoplasia: CIN 3) after conization with positive margin was 14.5%(n = 8).
Conclusion: Residual persistent dysplasia is not present in all patients after conization with positive margins. Cytology and colposcopy allow detection of dysplasia, indicating the need for a second conization. In women with no desire for further pregnancy, systematic repeat surgery must be recommended.
![]() Gynxe9;cologie Obstxe9;trique & Fertilitxe9;, Volume 34, Issue 12, December 2006, Pages 1178-1184 O. Graesslin, F. Dedecker, P. Collinet, E. Jouve, D. Urbaniack, J.-L. Leroy, J.-C. Boulanger, C. Quxe9;reux Abstract class="mlktScroll"> class="h3">Rxe9;sumxe9;La prise en charge de l'adxe9;nocarcinome in situ du col utxe9;rin (ACIS) est problxe9;matique. Le frxe9;quent jeune xe2;ge des patientes milite pour un traitement conservateur afin de prxe9;server la fertilitxe9; ultxe9;rieure et l'intxe9;gritxe9; corporelle de ces femmes jeunes. Cependant, plusieurs interrogations persistent quant xe0; la sxe9;curitxe9; carcinologique de cette attitude. Nous rapportons une revue de la littxe9;rature où la prise en charge conservatrice paraxee;t possible mais est associxe9;e sur le long terme xe0; un risque de rxe9;cidive estimxe9; entre 5 et 10 %avec une possible invasion dans environ 2 %des cas. La cylindrectomie cervicale doit xea;tre prxe9;fxe9;rxe9;e xe0; la classique conisation. La rxe9;section peut xea;tre thxe9;rapeutique et suffisante sous plusieurs conditions : rxe9;alisxe9;e au bistouri froid, avec une hauteur du cône de rxe9;section d'au moins 25 mm ; rxe9;alisation d'un curetage endocervical voire endomxe9;trial en fin de procxe9;dure et passage in sano sur l'histologie dxe9;finitive. Dans tous les cas, une surveillance cytologique voire histologique rxe9;gulixe8;re ainsi qu'une compliance sans failles de la patiente sont de rigueur ; l'association xe0; un testing viral peut apporter sa contribution surtout par sa valeur prxe9;dictive nxe9;gative. En revanche, xe0; chaque fois qu'il n'y a plus de dxe9;sir de grossesse, il semble logique et judicieux de proposer plutôt une hystxe9;rectomie qui reste le traitement standard permettant de simplifier la surveillance et d'xe9;viter pratiquement tout risque de rxe9;cidive.The management of adenocarcinoma in situ of the cervix (ACIS) is difficult because it is often diagnosed in younger women who may wish to preserve their potential of fertility. Conservative treatment has been accepted as an appropriate strategy but interrogations persist as to carcinological safety. We report a complete review of the literature on this subject where conservative attitude appears possible but is associated with recurrence risk (5 to 10%) and invasive disease (2%). Conditions to perform conservative management are: cold knife cone biopsy, negative margins, cone resection of at least 25 mm, realization of endocervical curettage and total patient compliance. In all cases, regular cytological and histological monitoring must be performed. If maintaining reproductive capacity is not desired, hysterectomy is systematically proposed to patient. cle&_coverDate=12%2F31%2F2006&_sk=999659987&view=c&wchp=dGLzVlz-zSkzV&md5=b596f85542f074c96ca52ea71f20abbd&ie=/sdarticle.pdf"> ![]() |
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