Clinicopathologic outcomes of laser conization for high-grade cervical dysplasia

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

Methods: 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.

Results: 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).

Conclusion: 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.

Laser conization; Thermal artifact; Postoperative complications; Persistent disease

[1] Dorsey J.H., Diggs E.S.: "Microsurgical conization of the cervix by carbon dioxide laser". Obstet. Gynecol., 1979, 54, 565.

[2] Mathevet P., Dargent D., Roy M., Beau G.: "A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP". Gynecol. Oneal., 1994, 54, 175.

[3] Oyesana O., Amerasinghe C., Manning E.: "Outpatient excisional management of cervical intraepithelial neoplasia: A prospective randomized comparison between loop diathermy excision and laser excisional conization". Am. J. Obstet. Gynecol., 1993, 168, 485.

[4] Paraskevaidi E., Kitchener H., Malamou-Mitsi V., Agnanti N., Lolis D.: "Thermal tissue damage following laser and large loop conization of the cervix". Obstet. Gynecol., 1994, 84, 752.

[5] Schiffman M.H., Bauer H.M., Hoover R.N. et al.: "Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia". J. Natl. Cancer Inst., 1993, 85, 958.

[6] Simons A.M., Mugica van Herckenrode C., Rodriguez J.A., Maitland N., Anderson M., Phillips D.H. et al.: "Demonstration of smoking-related DNA damage in cervical epithelium and correlation with human papillomavirus type 16, using exfoliated cervical cells". Br. J. Cancer. 1995, 71, 246.

[7] Simons A.M., Phillips D.H., Coleman D.V.: "DNA adduct assay in cervical epithelium". Diagn. Cytopathol., 1994, 10, 284.

[8] Coker A.L., Rosenberg A.J., McCann M.F., Hulka B.S.: "Active and passive cigarette smoke exposure and cervical intraepithelial neoplasia". Cancer Epidemiol. Biomarkers Prev., 1992, 1, 349.

[9] Brinton L.A., Hamman R.F., Huggins et al.: "Sexual and reproductive risk factors for invasive squamous cell cervical cancer". J. Natl. Cancer Inst., 1987, 79, 23.

[10] Odunsi K., Terry G., Ho L., Bell J., Cuzick J., Ganesan T.S.: "Susceptibility to human papillomavirus-associated cervical intraepithelial neoplasia is determined by specific HLA DRDQ alleles". Int. J. Cancer. 1996, 67, 595.

[11] Tay S.K., Jenkins D., Maddox P., Campion M., Singer A.: "Subpopulations of Langerhans'cells in cervical neoplasia". Br. J. Obstet. Gynaecol., 1987, 94, 10.

[12] Santos C., Galdos R., Alvarez M., Velarde C., Barriga 0., Dyer R., et al.: "One-session management of cervical intraepithelial neoplasia: a solution for developing countries". Gynecol. Oneal., 1996, 61, 11.

[13] Bostofte E.., Berget A., Falck Larsen J., Hjortkjaer Pedersen P., Rank F.: "Conization by carbon dioxide laser or cold knife in the treatment of cervical intra-epithelial neoplasia". Acta Obstet. Gynecol. Scand., 1986, 65, 199.

[14] Kristensen G., Jensen L., Holund B.: "A randomized trial comparing two methods of cold knife conization with laser conization". Obstet. Gynecol., 1990, 76, 1009.

[15] Larsson G., Alm P., Grundsell H.: "Laser conization versus cold knife conization". Surg., Gynecol. Obstet., 1982, 154, 59.

[16] F ine B., F einstein G., Sabella V.: "The pre- and postoperative value of endocervical curettage in the detection of cervical intraepithelial neoplasia and invasive cervical cancer". Gynecol. Oneal., 1998, 71, 46.