Cold Knife Versus Carbon Dioxide for the Treatment of Preinvasive Cervical Lesion
Author:
Ferrari Federico1, Bonetti Emma1ORCID, Oliveri Giulia1, Giannini Andrea2ORCID, Gozzini Elisa1ORCID, Conforti Jacopo1, Ferrari Filippo Alberto3ORCID, Salinaro Federica4, Tisi Giancarlo4, Ciravolo Giuseppe4, Favilli Alessandro5ORCID, Odicino Franco1
Affiliation:
1. Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy 2. Unit of Gynecology, “Sant’Andrea” Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy 3. Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, 37126 Verona, Italy 4. S.C. Ostetricia e Ginecologia, ASST Spedali Civili Brescia, Dipartimento Area Della Donna e Materno Infantile, 25136 Brescia, Italy 5. Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
Abstract
Background and Objectives: Cervical cancer (CC) represents a significant health concern worldwide, particularly for younger women. Cold knife (CK) conization and carbon dioxide (CO2) laser conization are two techniques commonly used to remove pre-invasive lesions, offering a potential curative intent in cases of incidental diagnosis of CC. This study aimed to assess the clinical implications and pathological outcomes of CK vs. CO2 laser conization for pre-invasive lesions. Materials and Methods: We retrospectively analyzed women who underwent CO2 or CK conization for high-grade preinvasive lesions (CIN2/3, CIS and AIS) between 2010 and 2022. Patient demographics, surgical details and pathological outcomes were collected. Pregnancy outcomes, including composite adverse obstetric rates, and oncological follow-up data, were also obtained. Results: In all, 1270 women were included; of them, 1225 (96.5%) underwent CO2, and 45 (3.5%) underwent CK conization. Overall, the rate of positive endocervical or deep margins was lower with CO2 laser compared to CK (4.3% vs. 13.3%, p = 0.015). Incidental CC was diagnosed in 56 (4.4%) patients, with 35 (62.5%) squamous and 21 (46.6%) adenocarcinomas. In a multivariate regression model, the relative risk for positive endocervical or deep margins is significantly greater in cases of incidental diagnosis of CC (p < 0.01). In cases of incidental diagnosis of CC, we found that the probabilities of having either positive endocervical or deep margins after CO2 laser or CK conization are similar, with a higher risk in case of adenocarcinoma lesion. Among women with CC, 42 (75%) opted for radical treatment, while 14 (25%) underwent a follow-up. Only one woman (7.1%) in the follow-up group, who had undergone CK conization, experienced a composite adverse obstetric outcome. No recurrences were observed after a median follow-up of 53 months. Conclusions: CO2 laser conization achieved a lower positive margin rate overall. CK and CO2 conization appear to be equivalent oncological options for incidental CC.
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