Cold Knife Conization

If the cytology report is positive, but no lesion is visible on gross or colposcopic examination, a cervical conization will be necessary in order to survey the entire squamoco-lumnar junction. A conization must also be performed if a previous punch biopsy of a grossly suspicious lesion showed that the noninvasive precancerous epithelium had not been completely excised. A biopsy of malignant tumors can never give information about the depth of invasion. If the clinical signs fail to reveal how deeply a tumor has invaded, e.g., a crater is seen, a conization must always be performed. This is the only method on which to base the decision of whether further treatment should consist of simple surgical procedures (enlarged cone or simple hysterectomy) or involve more extensive methods (radical surgery or irradiation). A conization should always contain the entire squamocolumnar junction. Depending upon the age of the patient (Hamperl and Kaufmann 1959), that junction may be localized on the ectocervix, as during the reproductive age, requiring a flat conus, or be up in the endocervical canal, as in old age, requiring an elongated conus (see Fig. 1). Since, however, neoplastic transformation of the endocervical reserve cells may extend into or even start in the endocervical canal, a large and elongated conus is often advisable in young patients, too. The cone should be marked so that the pathologist understands how it was located anatomically; the same marking procedure should be used in all cases. For example, a suture mark at "12 o'clock" will help the pathologist orient the specimen and pinpoint the site of a lesion on either the anterior or posterior lip, or both. Especially when a precancerous lesion

Conization

Geschlechtsreife It) Klimakterium.Menopause (2)

Fig. 1. Location of the squamocolumnar junction indicating zone of possible neoplastic transformation and shape of the conus usually recommended in reproductive age (1, for exception see text above) and in old age (2) (from Dallenbach-Hellweg 1985)

Geschlechtsreife It) Klimakterium.Menopause (2)

Fig. 1. Location of the squamocolumnar junction indicating zone of possible neoplastic transformation and shape of the conus usually recommended in reproductive age (1, for exception see text above) and in old age (2) (from Dallenbach-Hellweg 1985)

reaches the excisional margins of the cone, correct localization of the lesion will help the gynecologist in his follow-up treatment of the patient. The lateral margins of a cone may contain cervical glands that project deep into the tissue, possibly with precancerous lesions. Therefore, these parts of the tissue must also be carefully examined. To avoid the possibility of leaving the bottoms of glands behind, many surgeons prefer excising a more cylindrically shaped piece of cervical tissue.

In most instances, precancerous lesions are totally excised by conization and no further operation will be necessary. Accordingly, diagnostic conization serves also as a therapeutic measure. Occasionally cervical conization may be required as a means of treatment, e.g.,in patients with resistant vaginal discharge. Here, careful histological examination of the squamocolumnar junction is advisable to ensure that possible precancerous changes are not overlooked.

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Responses

  • jayden
    Why cold knife procedure?
    8 years ago

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