[Clinical morphology of cervical conization variants for high-grade squamous intraepithelial lesions].

Abstract

Surgical options for organ-preserving operations on the cervix (conization and contour-loop excision (C-LETZ)) regarding squamous intraepithelial lesions, morphological features of the cervix after surgery are determined, which are significant for HPV persistence and reproductive function.

Objective: To evaluate the results of a lifetime pathoanatomic examination of the surgical material of cervical conization with diathermy loops of various shapes and sizes - a triangular loop and a wavy C-LETZ loop.

Material and methods: The study included 49 patients with a clinical diagnosis of high-severity squamous intraepithelial lesion (HSIL), established by the results of a cytological smear examination or a previous histological examination of a cervical biopsy at the Moscow Regional Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky from 2016 to 2023. Histological examination of resected cervical cones (n=32) and wavy C-LETZ cones (n=17) was performed.

Results: At a cone height of less than 1.5 cm, both edges of the resection enter the section. With a higher cone height - 1.5-2cm - the endocervical edge of the resection can be examined by cutting and labeling it in a separate cassette. Undulating C-LETZ conization ensures excision of the crypts of the endocervix to a depth of 0.5 cm not only throughout, but also in the endocervical edge of the excision.

Conclusion: The analysis of the results of a lifetime pathoanatomic examination of the surgical material of conization with a triangular loop and a wavy C-LETZ loop showed the advantages and disadvantages of each of the studied variants of organ-preserving surgery. The advantage of wavy C-LETZ conization is the deep excision of the crypts of the endocervix throughout the cone, including the endocervical edge of conization.