Excisional treatment comparison for in situ endocervical adenocarcinoma (EXCISE): A phase 2 pilot randomized controlled trial to compare histopathological margin status, specimen size and fragmentation after loop electrosurgical excision procedure and cold knife cone biopsy.

Purpose/aim of the study: To investigate high-risk human papillomavirus (HPV) infection clearance following thin loop electrosurgical excision procedure (t-LEEP) among patients with cervica...

The Clearance of High-Risk Human Papillomavirus is Sooner After Thin Loop Electrosurgical Excision Procedure (t-LEEP)

Questioning the value of margin status in treated cervical precancer

The management and follow-up of patients diagnosed with adenocarcinoma in situ (AIS) is challenging. First, complete resection is difficult and cannot be guaranteed even though resection margins are negative. Second, patients with positive margins and/or positive endocervical curettage and/or histological signs of invasive disease have a very high risk of invasive adenocarcinoma. Therefore, the optimal management of these patients remains uncertain. A 15-year retrospective study was performed of patients with AIS treated in the Unit of Gynecology of Miguel Servet University Hospital, Zaragoza, Spain. During this period, a total of 18 women were diagnosed with AIS. Initial treatment consisted of cervical conization in all patients. Histological examination of the hysterectomy specimen showed the presence of residual disease in 60% of patients with positive margins, whose treatment was completed with a hysterectomy. All patients with negative cone margins who did not receive any complementary therapy were closely monitored and currently remain disease-free. Correspondence to: José Y, Department of Gynecology. Miguel Servet University Hospital. Number 1-3, Isabel la Catolica Road, Zaragoza, Spain; E-mail: yjosegu@hotmail.com

Evolution of endocervical adenocarcinoma in situ: A retrospective case series study

Endocervical curettage (ECC) is an optional practice during colposcopy, and the indication for endocervical curettage (ECC) is controversial between Europe and the USA. Here, we explored the value of ECC in a specific situation. An elderly post-loop electrosurgical excision procedure woman, who had undergone a colposcopy 4 months before, went for her follow-up and abnormal cytology was found, and both the ECC and punch biopsy showed negative results. Then, a second ECC was performed, which led to the diagnosis of a high-grade squamous intraepithelial lesion. This case report shows that ECC is useful for diagnosing elderly women with Type 3 squamocolumnar junction.

The importance of endocervical curettage in an old post-loop electrosurgical excision procedure woman with abnormal cervical cytology and a normal punch biopsy histology: A case report and literature review

Introduction Adenocarcinoma in situ (AIS) of the uterine cervix is the precursor to invasive endocervical adenocarcinoma. An excisional biopsy such as a cold knife cone biopsy (CKC) should be performed to exclude invasive adenocarcinoma. Loop electrosurgical excision procedure (LEEP) is an alternative modality to CKC but is controversial in AIS. There is a perception that there is a greater likelihood of incomplete excision of AIS with LEEP because the depth of excised tissue tends to be smaller and the tissue margins may show thermal artefact which can interfere with pathology assessment. In the USA, guidelines recommend that any treatment modality can be used to excise AIS, provided that the specimen remains intact with interpretable margins. However, there are no high-quality studies comparing LEEP with CKC and well-designed prospective studies are needed. If such a study were to show that LEEP was non-inferior to CKC for the outcomes of post-treatment persistence, recurrence and adenocarcinoma, LEEP could be recommended as an appropriate treatment option for AIS in selected patients. This would benefit women because, unlike CKC, LEEP does not require general anaesthesia and may be associated with reduced morbidity. Methods and analysis The proposed exploratory study is a parallel group trial with an allocation ratio of 2:1 in favour of the intervention (LEEP: CKC). Participants are women aged ≥18 to ≤45 years diagnosed with AIS on cervical screening and/or colposcopically directed biopsy in Australia and New Zealand, who are to receive excisional treatment in a tertiary level centre. Ethics and dissemination Ethical approval for the study has been granted by the St John of God Healthcare Human Research Ethics Committee (reference number #1137). Results from the study will be presented at conferences and published in a peer-reviewed scientific journal. Registration ANZCTR registration number ACTRN12617000132347 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372173&isReview=true

/pdf/excisional-treatment-in-women-with-cervical-adenocarcinoma-57yuynmtuc.pdf

Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled non-inferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study

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Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled non-inferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study