Search Results (3)

Background: Cervical cancer is one of the most common cancers in women worldwide, with the leading risk factor being high-risk human papillomavirus (HR-HPV); persistent HR-HPV infection leads to cervical dysplasia. With early screening and, if indicated, therapeutic strategies such as a loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone (LLETZ), morbidity and mortality in this population are decreasing. However, it is suspected that these procedures may have an impact on sexual dysfunction. Methods: In this single-center prospective longitudinal study, we recruited patients with a high-grade squamous intraepithelial lesion (HSIL) and HR-HPV-positive result and evaluated the impact of LEEP/LLETZ on their sexual life and psychological well-being. All participants received two questionnaires—the Female Sexual Function Index (FSFI) and the Brief Index of Sexual Function-Women (BISF-W)—after diagnosis, before treatment, and three months after the procedure. Results: A total of 40 women aged 28 to 55 years were enrolled. This study showed no significant changes in both the FSFI (F(1,39) = 0.774; p = 0.38) and BISF-W total scores (F(1,39). This study revealed that 32/40 (80%) of participants based on the FSFI either exhibited no change or improved sexual function. Only 3/40 (7.5%) mentioned sexual dysfunction after procedures. This study also found that the mean score for sexual function based on the FSFI was 2.80; p = 0.102. Conclusions: These findings suggest that patients who qualified for LEEP/LLETZ can be reassured that the anxiety they experience prior to treatment is not necessarily justified. This provides evidence of the safety of loop excision procedures in terms of sexual functioning after the procedure. Nevertheless, further studies are needed to analyze the potential risk factors that may contribute to adverse sexual outcomes and to achieve a better understanding of this complex problem. Full article

The objective of this research is to evaluate cervical regeneration after large loop excision of the transformation zone (LLETZ) through the identification of a new sonographic reference point at the level of the uterine margins. In the period March 2021–January 2022, a total of 42 patients affected by CIN 2–3 were treated with LLETZ at the University Hospital of Bari (Italy). Before performing LLETZ, cervical length and volume were measured with trans-vaginal 3D ultrasound. From the multiplanar images, the cervical volume was obtained using the Virtual Organ Computer-aided AnaLysis (VOCAL™) program with manual contour mode. The line that connects the points where the common trunk of the uterine arteries reaches the uterus splitting into the ascending major branch and the cervical branch was considered as the upper limit of the cervical canal. From the acquired 3D volume, the length and the volume of the cervix were measured between this line and the external uterine os. Immediately after LLETZ, the removed cone was measured using Vernier’s caliper, and before fixation in formalin, the volume of the excised tissue was evaluated by the fluid displacement technique based on the Archimedes principle. The proportion of excised cervical volume was 25.50 ± 17.43%. The volume and the height of the excised cone were 1.61 ± 0.82 mL and 9.65 ± 2.49 mm corresponding to 14.74 ± 11.91% and 36.26 ± 15.49% of baseline values, respectively. The volume and length of the residual cervix were also assessed using 3D ultrasound up to the sixth month after excision. At 6 weeks, about 50% of cases reported an unchanged or lower cervical volume compared to the baseline pre-LLETZ values. The average percentage of volume regeneration in examined patients was equal to 9.77 ± 55.33%. In the same period, the cervical length regeneration rate was 69.41 ± 14.8%. Three months after LLETZ, a volume regeneration rate of 41.36 ± 28.31% was found. For the length, an average regeneration rate of 82.48 ± 15.25% was calculated. Finally, at 6 months, the percentage of regeneration of the excised volume was 90.99 ± 34.91%. The regrowth percentage of the cervical length was 91.07 ± 8.03%. The cervix measurement technique that we have proposed has the advantage of identifying an unequivocal reference point in 3D cervical measurement. Ultrasound 3D evaluation could be useful in the clinical practice to evaluate the cervical tissue deficit and express the “potential of cervical regeneration” as well as provide the surgeon useful information about the cervical length. Full article

Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have been made in the last decade. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled clinical trials reporting on the efficacy and safety of diagnostic and therapeutic interventions for cervical dysplasia. Data were analyzed according to PRISMA guidelines. In total, 33 studies reporting on 5935 women were identified. We recommend intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored 1 min after the application of acetic acid and should be followed by Lugol’s iodine test for an optimal yield of LSIL/HSIL. LEEP/LLETZ remains the standard and techniques such as SWETZ, C-LETZ, and TCBEE are not superior. LEEP/LLETZ should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with LSIL, especially in women with HIV infection, but LEEP/LLETZ remains the standard for HSIL. Topical imiquimod remains an experimental procedure. In conclusion, significant progress has been made in the last decade regarding both diagnostic interventions as well as therapeutic interventions for women with cervical dysplasia. Based on >30 controlled clinical trials, we were able to formulate specific and evidence-based recommendations. Full article