What does cervical conization mean?

Cervical conization is a surgical treatment in obstetrics and gynecology to remove the cervix, which means cutting off a part of the cervical tissue in a cone shape from the outside to the inside. On the one hand, it is used to facilitate pathological examination and diagnosis of cervical diseases; on the other hand, it is also a treatment method to remove the diseases.

Cervical conization surgery details

Cervical conization surgery was initially performed with a scalpel (i.e., cold knife cone biopsy), which had the advantage of clear cutting edges, which was conducive to pathological examination. The disadvantages are that it requires hospitalization, anesthesia, a long operation time, and it is very easy to bleed profusely during the operation.

Nowadays, loop electrosurgical excision procedure (also known as LEEP knife) has been vigorously developed. Its advantages are simple and easy to perform, no need for hospitalization, and the operation time is short, only about 5 to 10 minutes.

However, whether the LEEP knife can cut deep enough has been questioned, and because the medical community used to be concerned that the electric current would damage the cutting edge, it has not advocated the use of electrosurgical cone biopsy. However, after summarizing many medical practices and clinical materials in recent years, it is found that the effect of electrosurgical cone biopsy is similar to that of cold knife cone biopsy, and there is less bleeding. There was no significant difference between the two groups in terms of elimination and recurrence of the disease. The detection rate of cervical resection margin during cervical conization increases with the severity of the disease. As we all know, patients with positive cone biopsy margins have a high probability of disease progression and recurrence, but those with negative margins cannot be guaranteed to have residual lesions in the cervix. The incidence of residual lesions is also proportional to the severity of the lesions, but the chance of occurrence is lower than that of patients with positive margins. Endocervical duct involvement and the multicentricity of the lesions are the fundamental factors for residual or recurrence of lesions after cone biopsy. In short, loop electrosurgical excision has become the best cone cutting method because of its time-saving, simplicity, safety and cost-effectiveness. It is enough to be vigorously developed in clinical medicine.

There is still controversy about cervical conization in pregnant women. Some experts and scholars believe that cone biopsy on pregnant women may lead to premature births and low-birth-weight babies, while others believe that the detection rate of cutting edges and the incidence of residual disease are high. However, most people believe that cone biopsy during pregnancy is safe and reasonable. Raio L et al. proposed that after adjusting for known risk factors, a cone biopsy depth of more than 10 mm in pregnant women is a fundamental factor in the occurrence of premature babies. Therefore, the cone biopsy depth of pregnant women should be less than 10mm, which requires more stringent selection of the application range of cone biopsy.

The pathology of cone biopsy must indicate whether the cutting margin is positive, whether the endocervical glandular duct is involved, and whether the lesion is multicentric.

Cervical conization surgery treatment scope

1. If malignant cells are found in cervical smear cytology examination several times, colposcopy is normal, and cervical puncture biopsy or segmental curettage of the endocervical canal is negative, cervical conization should be performed for further diagnosis.

2. Cervical puncture biopsy has diagnosed high-grade cervical intraepithelial lesions (HSIL, including CINII-III, cervical carcinoma in situ), cervical adenocarcinoma in situ, and subtle cervical infiltration (cervical cancer Ia1) under the microscope. In order to determine the scope of surgical treatment, cervical conization can be performed first, and cervical tissue can be removed for further pathological examination to determine the degree of disease and guide the selection of surgical treatment scope.

3. Patients suspected of cervical adenocarcinoma, but with negative results of cervical puncture biopsy or endocervical curettage.

4. Patients with chronic cervicitis who have cervical hypertrophy, hyperplasia, and outward tilt and who have not responded well to conservative treatment can undergo small-scale cervical conization.