THE CLINICAL AND TECHNICAL FEATURES OF ELECTROSURGICAL CONIZATION OF THE CERVIX UTERI IN PATIENTS WITH CERVICAL INTRAEPITHELIAL NEOPLASIA III

Objective. To determine the most common technical errors of electrosurgical conization, which worsen the diagnostic and therapeutic capacities of surgery in patients with cervical intraepithelial neoplasia (CIN) III and microinvasive carcinoma of the cervix uteri (CCU). Subjects and methods. The study enrolled 474 patients with CIN III and microinvasive CCU who had undergone conization at the Russian Cancer Research Center and 85 patients after conization in other institutions. Histological specimens were reconsidered; the removed cone, resection margins, and scrapes were evaluated. The reasons for incomplete removal of the neoplastic epithelium (positive resection margins) were analyzed. Results. The positive endocervical resection margin was more common in women over 35 years of age and particularly common in postmenopause, which is associated with the inadequate choice of a «sail» and with its incomplete insertion due to canal stenosis. In patients with postpartum ruptures, inadequate excision was associated with the impossibility of placing an electrode in the deformed patulous canal and an incision along the neoplastic epithelium of crypta. The most common reasons for hampered interpretation of the degree of neoplasia and resection margins by the material of conization were carbonization and coagulation of cone margins (5.2%), non-fulf illment of curettage of the endocervical canal (4.5%) or its curettage up to conization (4.1%), as well as cone fragmentation (2.9%). The inadequate sequence of manipulations — curettage up to conization — makes it impossible to evaluate the endocervical margin in patients with signs of neoplasia in their scrapes. Conclusion. To avoid the artifacts of a cone, the “sail” electrode in postpartum cervical deformities should be pressed against the patulous canal wall on the side of incision. For postmenopausal patients, it is necessary to bougie the stenotic canal for the adequate insertion of the “sail” and the latter should be chosen, by orienting to the size of the cervix rather than the outlines of lesions visible on the ectocervix. When the altered epithelium of the ectocervix is located in close proximity to the cone margin, additional excisions of the ectocervical margin reduce the likelihood of obtaining the positive resection margins. Radiosurgical conization should be preferred to diathermoconization and the incision mode to the coagulation mode. Conization must necessarily be supplemented by cervical canal curettage, by performing it after cone removal, which will provide a precise evaluation of the endocervical margin status.

electrosurgical conization of the cervix uteri, cervical intraepithelial neoplasia