The Fischer Cone Biopsy Excisor Compared with the Large Loop Electrode for Cervical Conizations.

Autor: Fischer, Nathan R., Alexanderian, David, Gagliardi, Stephen, Oglesby, John, Scribner, Dennis, Asuncion, Celedonio, Mesologitis, Thalia
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Zdroj: Journal of Lower Genital Tract Disease; Jul1999, Vol. 3 Issue 3, p180-184, 5p, 6 Diagrams, 4 Charts
Abstrakt: Abstract Objective. Our objective was to compare the cone biopsy excisor (CBE) to the loop electrosurgical electrode with respect to fragmentation, thermal damage, and the margin’s evaluation of the conization specimen. Methods. After approval by the institutional review boards of Mt. Sinai, St. Francis, and Hartford hospitals (Hartford, CT), patients were assigned randomly to the CBE or to a loop electrosurgical excision procedure (LEEP). Data were collected from August 1994 to July 1998. Inclusion criteria were biopsy-proven cervical intraepithelial neoplasia grade 2 or 3, inadequate colposcopy, positive endocervical curettage, or cytohistological discrepancy. One hundred thirty-six patients were assigned randomly to the CBE, and 139 patients were assigned randomly to LEEP. The wattage ranged from 35 to 50 W using a blend setting (80/20 of cutting and coagulation). After tissue diagnosis, the specimens were analyzed at the margins for thermal damage and ease of evaluation. Results. 121/136 (89%) of CBE and 34/139 (24%) loop electrode cases submitted one specimen to pathology, χ2 = 116.31; p < .001. Margins could not be interpreted because of thermal damage in 2 of 136 specimens (1.5%) in the CBE patients and in 24 of 139 (17.3%) in the LEEP patients (χ2 = 20.3; p < .001). The margins were involved with disease in 11 of 136 patients in the CBE group and in 24 of 139 patients in the LEEP group (χ2 = 28.2; p < .001). Conclusion. The CBE provides cervical specimens with less fragmentation and thermal damage, and with margins that are easier to evaluate and are less involved with disease than the specimens obtained with the electrosurgical loop excision electrodes. [ABSTRACT FROM AUTHOR]
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