Research Article
BibTex RIS Cite

Analysis of Cold-knife Conization Results in HPV Positive Patients

Year 2019, Volume: 9 Issue: 1, 95 - 99, 27.03.2019
https://doi.org/10.16899/gopctd.465826

Abstract



Aim:



To perform the retrospective analysis of cases with
cold-knife conization operation. We aimed to determine the risk of positive
surgical margins in HPV 16/18 positivite and postmenapausal women.



Materials and Methods:



After approval of the Ethical Commitee, the medical
record of patients who had undergone a cold-knife conization surgical procedure
in our clinic between January 2015 and July 2017 were reviewed.  We included 51 cold-knife conization case
that were referred to us for HPV positivity. We  have investigated parameters such as age,
menopausal status, cervical smear, human papilloma virus (HPV), colposcopic
biopsy / conization histopathological evaluation and positive surgical margin. HPV
analysis results were grouped as follows to investigate the effect of HPV 16
and 18. Group I: positivity of HPV 16 and / or 18, group II: other high risk
(HR) HPV positivite (HPV 16/18 negative). Cold-knife conization results were divided
in two groups; normal/low dysplasia group (Normal and CIN I), severe dysplasia
group (CIN II / III and CIS).



Results:



Cervical smear results were as follows; Normal 27
(52.9%), ASCUS 2 (3.9%), LGSIL 14 (27.5%) and HSIL 8 (15.7%). The results of
colposcopy were as follows; CIN I 18 (35.3%), CIN II / III 33 (64.7%). Cold-knife
conization histopathological results were as follows; 12 (23.5%) normal, 8
(15.7%) CIN I, 23 (45.1%) CIN II / III, 8 (15.7%) CIS.



28 patients were in group I (HPV 16/18 positive),
whereas 23 patients were in group II ( other HR-HPV positive).



Normal/low dysplasia rate was 35.7% (10/28), severe
dysplasia rate was 64.3% (18/28), positive surgical margin rate was 21.4%
(6/28) in the group I. And normal/low dysplasia rate was 43.5% (10/23), severe
dysplasia rate was 56.5% (13/23), positive surgical margin rate was 8.6% (2/23)
in the group II.



In generally positive surgical margin rate after cold-knife
conization operation was 15.7% (8/51). In postmenopausal patients, more positivite
surgical magrin was detected (21.1% - 12.5%).



Conclusion:



We know that HPV 16 and 18 are more effective than
other HR HPVs in the etiopathogenesis of cervical cancer. But there was no
significant difference between the groups in terms of severe dysplasia and positive
surgical margin. We think that more extensive studies will give clearer
results. We also think more emphasis should be given to HR HPVs in routine
screening, colposcopy follow-up and vaccination program in this data light.

References

  • 1. Cooper DB, Menefee GW. Conization Of Cervix. NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 January.2. Walboomers JM, Jacobs MV, Manos MM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology 1999;189:12-9.3. Basu P, Chandna P, Bamezai RN et al. MassARRAY spectrometry is more sensitive than PreTect HPV-Proofer and consensus PCR for type-specific detection of high-risk oncogenic human papillomavirus genotypes in cervical cancer. Journal of Clinical Microbiology 2011;49:3537-44.4. Kirschner B, Junge J, Holl K et al. HPV genotypes in invasive cervical cancer in Danish women. Acta Obstetricia et Gynecologica Scandinavica 2013;92:1023-31.5. Cubie HA. Diseases associated with human papillomavirus infection. Virology 2013;445:21-34.6. Duggan BD, Felix JC, Muderspach LI et al. Cold-knife conization versus conization by the loop electrosurgical excision procedure: A randomized, prospective study. American Journal of Obstetrics and Gynecology 1999;180:276-82.7. Human Papillomavirus and Related Diseases Report 27 July 2017. ICO/IARC Information Centre on HPV and Cancer. http://www.hpvcentre.net/statistics/reports/XWX.pdf8. Humans IWGotEoCRt (2012) Biological agents. Volume 100 B. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum 100:1–441.9. Gultekin M, Karaca MZ, Kucukyildiz I et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. International Journal of Cancer 2018;142:1952-8.10. Baser E, Ozgu E, Erkilinc S et al. Clinical Outcomes of Cases with Absent Cervical Dysplasia in Cold Knife Conization Specimens. Asian Pacific Journal of Cancer Prevention 2013;14(11):6693-6.11. Jiang YM, Chen CX, Li L. Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia. Onco Targets and Therapy 2016;9:3907-15.12. Ulrich D, Tamussino K, Petru E et al. Conization of the Uterine Cervix: Does the Level of Gynecologist’s Training Predict Margin Status? International Journal of Gynecologic Pathology 2012;31(4):382-6.13. Oz M, Cetinkaya N, Korkmaz E et al. Optimal cone size to predict positive surgical margins after cold knife conization (CKC) and the risk factors for residual disease Journal of Turkisch German Gynecological Association 2016;17:159-62.14. de Sanjose S, Quint WG, Alemany L et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncology 2010;11:1048-56.

HPV Pozitif Hastalarda Soğuk Konizasyon Sonuçlarının Analizi

Year 2019, Volume: 9 Issue: 1, 95 - 99, 27.03.2019
https://doi.org/10.16899/gopctd.465826

Abstract

Amaç:



Çalışmamızda soğuk konizasyon operasyonu olan
hastaların retrospektif analizini yapmak. Amacımız konizasyon sonrası cerrahi
alan pozitifliği olan hastalarda HPV 16/18 pozitifliği ve menapozal durumun
etkisini ortaya koymayı amaçladık.



Gereç ve Yöntem:



Etik kurul onayı sonrası Ocak 2015 ile Temmuz 2017
arasında kliniğimizde soğuk konizasyon ameliyatı olan hastaların medikal
kayıtları incelendi. HPV pozitifliği nedeniyle yaönlendirilen 51 soğuk
konizasyon vakası çalışmaya dahil edildi. Yaş, menapozal durum, servikal smear,
Human papillomavirüs (HPV), kolposkopik biyopsi / konizasyon histopatolojik
değerlendirmesi ve cerrahi sınır pozitifliği değerlendirildi. HPV 16 ve 18’in
etkisini değerlendirmek için hastalar iki gruba ayrıldı; Grup I: HPV 16 ve/veya
18 pozitifliği, grup II: diğer yüksek riskli (HR) HPV pozitifliği (HPV 16/18
negatif). Soğuk konizasyon sonuçları da iki gruba ayrıldı; normal/düşük
displazi grup (Normal and CIN I), ağır displazi grup (CIN II / III and CIS).



Bulgular:



Servikal smear sonuçları şu şekilde idi; Normal 27
(52.9%), ASCUS 2 (3.9%), LGSIL 14 (27.5%) and HSIL 8 (15.7%). Kolposkopi
sonuçları ise şöyle idi; CIN I 18 (35.3%), CIN II / III 33 (64.7%). Soğuk
konizasyon sonuçları ise şu şekilde idi; 12 (23.5%) normal, 8 (15.7%) CIN I, 23
(45.1%) CIN II / III, 8 (15.7%) CIS.



28 hasta grup I (HPV 16/18 pozitif) iken 23 hasta
grup II (diğer yüksek riskli HPV pozitif) olarak bulundu.



Grup I’de normal/düşük displazi oranı 35.7% (10/28),
ağır displazi oranı 64.3% (18/28), cerrahi sınır pozitifliği oranı 21.4% (6/28)
idi.  in the group I. Grup II’de ise
normal/düşük displazi oranı 43.5% (10/23), ağır displazi oranı 56.5% (13/23),
cerrahi sınır pozitifliği oranı 8.6% (2/23) idi.



Sonuç olarak konizasyon sonrası cerrahi sınır
pozitifliği 15.7% (8/51) olarak bulundu. Postmenapozal hastalarda ise daha
fazla cerrahi sınır pozitifliği saptandı(21.1% - 12.5%).



Sonuç:



Serviks kanseri etyopatogenezinde HPV 16 ve 18’in
diğer yüksek riskli HPV’lere oranla daha etkili olduğunu biliyoruz. Ancak
çalışmamızda gruplar arasında ağır displazi ve cerrahi sınır pozitifliği
açısından anlamlı bir fark saptamadık. Daha ileri çalışmalar ile daha net
sonuçlar alınabileceğini düşünmekteyiz. Bu bilgiler ışığında rutin tarama,
kolposkopi takibi ve aşılama programlarında diğer yüksek riskli HPV’lere
gereken önemin verilmesi gerektiğini düşünüyoruz.   

References

  • 1. Cooper DB, Menefee GW. Conization Of Cervix. NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 January.2. Walboomers JM, Jacobs MV, Manos MM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology 1999;189:12-9.3. Basu P, Chandna P, Bamezai RN et al. MassARRAY spectrometry is more sensitive than PreTect HPV-Proofer and consensus PCR for type-specific detection of high-risk oncogenic human papillomavirus genotypes in cervical cancer. Journal of Clinical Microbiology 2011;49:3537-44.4. Kirschner B, Junge J, Holl K et al. HPV genotypes in invasive cervical cancer in Danish women. Acta Obstetricia et Gynecologica Scandinavica 2013;92:1023-31.5. Cubie HA. Diseases associated with human papillomavirus infection. Virology 2013;445:21-34.6. Duggan BD, Felix JC, Muderspach LI et al. Cold-knife conization versus conization by the loop electrosurgical excision procedure: A randomized, prospective study. American Journal of Obstetrics and Gynecology 1999;180:276-82.7. Human Papillomavirus and Related Diseases Report 27 July 2017. ICO/IARC Information Centre on HPV and Cancer. http://www.hpvcentre.net/statistics/reports/XWX.pdf8. Humans IWGotEoCRt (2012) Biological agents. Volume 100 B. A review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum 100:1–441.9. Gultekin M, Karaca MZ, Kucukyildiz I et al. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. International Journal of Cancer 2018;142:1952-8.10. Baser E, Ozgu E, Erkilinc S et al. Clinical Outcomes of Cases with Absent Cervical Dysplasia in Cold Knife Conization Specimens. Asian Pacific Journal of Cancer Prevention 2013;14(11):6693-6.11. Jiang YM, Chen CX, Li L. Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia. Onco Targets and Therapy 2016;9:3907-15.12. Ulrich D, Tamussino K, Petru E et al. Conization of the Uterine Cervix: Does the Level of Gynecologist’s Training Predict Margin Status? International Journal of Gynecologic Pathology 2012;31(4):382-6.13. Oz M, Cetinkaya N, Korkmaz E et al. Optimal cone size to predict positive surgical margins after cold knife conization (CKC) and the risk factors for residual disease Journal of Turkisch German Gynecological Association 2016;17:159-62.14. de Sanjose S, Quint WG, Alemany L et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncology 2010;11:1048-56.
There are 1 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Deha Denizhan Keskin

Publication Date March 27, 2019
Acceptance Date January 18, 2019
Published in Issue Year 2019 Volume: 9 Issue: 1

Cite

APA Keskin, D. D. (2019). Analysis of Cold-knife Conization Results in HPV Positive Patients. Çağdaş Tıp Dergisi, 9(1), 95-99. https://doi.org/10.16899/gopctd.465826
AMA Keskin DD. Analysis of Cold-knife Conization Results in HPV Positive Patients. J Contemp Med. March 2019;9(1):95-99. doi:10.16899/gopctd.465826
Chicago Keskin, Deha Denizhan. “Analysis of Cold-Knife Conization Results in HPV Positive Patients”. Çağdaş Tıp Dergisi 9, no. 1 (March 2019): 95-99. https://doi.org/10.16899/gopctd.465826.
EndNote Keskin DD (March 1, 2019) Analysis of Cold-knife Conization Results in HPV Positive Patients. Çağdaş Tıp Dergisi 9 1 95–99.
IEEE D. D. Keskin, “Analysis of Cold-knife Conization Results in HPV Positive Patients”, J Contemp Med, vol. 9, no. 1, pp. 95–99, 2019, doi: 10.16899/gopctd.465826.
ISNAD Keskin, Deha Denizhan. “Analysis of Cold-Knife Conization Results in HPV Positive Patients”. Çağdaş Tıp Dergisi 9/1 (March 2019), 95-99. https://doi.org/10.16899/gopctd.465826.
JAMA Keskin DD. Analysis of Cold-knife Conization Results in HPV Positive Patients. J Contemp Med. 2019;9:95–99.
MLA Keskin, Deha Denizhan. “Analysis of Cold-Knife Conization Results in HPV Positive Patients”. Çağdaş Tıp Dergisi, vol. 9, no. 1, 2019, pp. 95-99, doi:10.16899/gopctd.465826.
Vancouver Keskin DD. Analysis of Cold-knife Conization Results in HPV Positive Patients. J Contemp Med. 2019;9(1):95-9.