Conization
Conization, also known as cone biopsy, is a surgical procedure performed on the cervix to diagnose and treat precancerous lesions or cervical cancer. It is typically indicated when results from a Pap test and colposcopy are inconclusive or fail to provide a clear diagnosis. During the procedure, a cone-shaped section of tissue is removed from the cervix, allowing for a definitive pathological examination. This intervention can be both diagnostic and therapeutic, especially if the entire lesion is excised without affecting surrounding organs.
Before the surgery, patients undergo a preoperative evaluation, and they must refrain from eating or drinking the night before. The procedure involves administering anesthesia, visualizing the cervix, and carefully excising the tissue using a circular incision. Post-surgery, patients are monitored until they stabilize and can be discharged, often on the same day.
While conization can effectively treat certain cervical abnormalities, it carries risks, including miscarriage for those planning future pregnancies and potential complications like excessive bleeding or cervical scarring. The results of the histologic examination post-conization can indicate either benign growth or the presence of cancerous cells, guiding subsequent treatment decisions.
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Subject Terms
Conization
Also known as: Cone biopsy, cold-knife conization, loop electrosurgical excision procedure (LEEP)
Definition:Conization is the surgical excision of an en bloc section of the cervix to diagnose suspicious lesions that may be precancerous or overt cancer.
Cancers diagnosed: Precancerous lesions, such as high-grade suspicious intraepithelial lesions (HGSIL) or cervical intraepithelial neoplasia II or III; cervical cancer
Why performed: Conization of the cervix is performed when complete microscopic visualization (colposcopy) of all lesions is inadequate or inconclusive or reveals inconsistent results when compared to a Pap test. Although a Pap test and colposcopy detect 58 to 89 percent of all precancerous and cancerous lesions, conization can provide a definite pathological diagnosis. Conization can also be therapeutic if the entire lesion is removed and frank involvement of other organs (vagina, uterus bladder, or rectum) is absent.
Patient preparation: The patient undergoes preoperative evaluation, including blood workups to determine her fitness to undergo surgery and general anesthesia. Patients are instructed to take nothing by mouth the night before the procedure.
Steps of the procedure: After the patient is anesthetized and prepared, the cervix is visualized. Local anesthesia is administered if the patient is not under general anesthesia. The cone base area is determined by applying Lugol’s solution. The uterine depth is determined prior to incising. The incision is made in a circular, centrally angled fashion. A suture at the twelve o’clock position of the specimen is placed. Curettage of the remaining ectocervix is done to detect any lesions above the cone tip. Cautery or ligation of any bleeding vessels and vaginal packing is done.
After the procedure: The patient is monitored in the postanesthesia care unit until she is fully awake and ambulatory and her vital signs are stable. Once stable in unit, the patient may be discharged on the same day. Admission for overnight observation is warranted if the patient is unstable or other medical problems need to be managed.
Risks: The most significant risk is miscarriage in women (10 percent) who intend to become pregnant after conization. Only specialists experienced in managing the potential complications should care for these patients. Other risks include excessive intraoperative or postoperative bleeding for as many as ten to fourteen days (30 percent), cervical narrowing as a result of scarring, perforation of adjacent organs, and infertility.
Results: A benign histologic examination of the specimens may reveal increased but orderly normal cell growth within the lesion but no elements of disordered growth of abnormal cells. Histologic examination of the specimens that reveals disordered proliferation and abnormal cellular characteristics is suggestive of cervical cancer.
Bibliography
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Amer. Soc. for Colposcopy and Cervical Pathology. Cone Biopsy. N.p.: ASCCP, 2010. Digital file.
Costales, A. B., et al. "Risk of Residual Disease and Invasive Carcinoma in Women Treated for Adenocarcinoma in Situ of the Cervix." Gynecologic Oncology 129.3 (2013): 513–516. PubMed. Web. 19 Sept. 2014.
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