3D ultrasound as a surgical quality control of conization in patients with severe dysplasia: a prospective study
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GENERAL GYNECOLOGY
3D ultrasound as a surgical quality control of conization in patients with severe dysplasia: a prospective study Anna M. Dückelmann1 · Julia Wordell2 · Rolf Richter1 · Jalid Sehouli1 Received: 6 June 2020 / Accepted: 27 July 2020 © The Author(s) 2020
Abstract Purpose To compare the techniques for cone measurement with ultrasound to determine the size of the resected tissue and to evaluate parameters which may be relevant for stratifying women at risk who need surveillance when pregnant. Methods The present study included women with a pathological cervical biopsy. Cervical length and volume were determined by transvaginal ultrasound prior to conization. The pathologist measured the volume of the removed tissue by the fluid displacement technique and using a ruler. A repeat transvaginal ultrasound was performed during a follow-up visit. Factors affecting cone volume as well as the correlation between measurement techniques were analyzed. Results A total of 28 patients underwent cervical excision treatment. The mean cervical volumes measured sonographically before and after the operation were 17.72 ± 7.34 and 13.21 ± 5.43 c m3, respectively. The proportion of volume excised was 25.50 ± 17.43%. A significant correlation was found between the cone depth and the cone volume measured by the fluid displacement technique, and histopathologically and sonographically measured difference in cervical volume. The interobserver reliability coefficient was > 0.9. Analyzing influential parameters, only age affected the extent of cone volume and the correlation between the three measurement techniques. Conclusion Commonly applied techniques of cervical and cone measurement are equivalent and interchangeable. Our ultrasound data show variety in the volume and length of the cervix, and in the proportion of the volume excised at conization. Ultrasound measurements may help the surgeon to estimate not only the dimension of the remaining cervix but also its function. Keywords 3D ultrasound · Cervical dysplasia · Conization · Cervical volume · Cervical length · Transvaginal ultrasound
Introduction The implementation of cervical carcinoma screening in various countries and the introduction of HPV vaccination have contributed to a significant decrease in the incidence and mortality rates for this cancer [1]. Nevertheless, cervical cancer remains a threat to women’s lives globally [2]. A decrease in invasive cervical cancer is ensured by the timely diagnosis and appropriate treatment of high-grade preinvasive cervical lesions using cytology. The methods of choice for treating cervical intraepithelial neoplasia (CIN) * Anna M. Dückelmann anna‑[email protected] 1
Department of Gynecology, Medical University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Department of Gynecology, Ruppiner Kliniken, Fehrbelliner Str. 38, 16816 Neuruppin, Germany
2
are loop electrosurgical excision procedure (LEEP) and carbon dioxide laser cervical excision [3]. These procedures allow the degree of abno
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