You need treatment to remove early-stage cervical cancer (stage 0 or IA1). CIN II: Moderate to marked cervical dysplasia. By using this website, you agree to our This review will focus mainly on the cold knife cone procedure. General recovery tips include: Avoid lifting heavy objects or aerobic exercises for two weeks. Patients with a minimum of 12months of spontaneous amenorrhea were considered post-menopausal.This study conforms to the provisions of the Declaration of Helsinki (as revised in Tokyo 2004). We avoid using tertiary references. 2020. doi:10.3322/caac.21628, Kindinger L, Kyrgiou M, MacIntyre D, et al. A cone biopsy is also considered a potential treatment for the following: There are three ways to perform a cone biopsy and the approach is determined by where cancer or precancerous cells are located in the cervix: If the edges of the biopsy have cancer cells, the cone biopsy may need to be repeated or a radical trachelectomy (removal of the cervix as well as upper vagina and nearby tissue) may be considered. Cytological analysis and HR-HPV DNA test are the main methods for cervical cancer screening. Milojkovic M. Residual and recurrent lesions after conization for cervical intraepithelial neoplasia grade 3. Next, your surgeon will remove abnormal tissue in addition to some normal tissue surrounding it. Call us at 833-347-1665 to make an appointment. Schedule a follow-up appointment with your doctor six weeks after your biopsy. If the cone biopsy removes all of the abnormal tissue, you will still need to be monitored. 2017;141(1):8-23.doi:10.1002/ijc.30623, Santesso N, Mustafa RA, Wiercioch W, et al. For the procedure, you'll be lying on your back with your feet in stirrups to keep your legs apart to provide access to your cervix. 1997;89:41922. An obstetrician-gynecologist (Ob/Gyn) performs a cone biopsy. Ghaem-Maghami S, Sagi S, Majeed G, et al. HHS Vulnerability Disclosure, Help Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society, Preterm birth prevention post-conization: A model of cervical length screening with targeted cerclage, Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: Systematic review and meta-analysis, WHO guidelines for treatment of cervical intraepithelial neoplasia 23 and adenocarcinoma in situ: Cryotherapy, large loop excision of the transformation zone, and cold knife conization, Pain, redness, or swelling in one or both of your legs. Darwish AM, Kamel MA, Zahran K, et al. Fever. In total, 110 of the 120 post-menopausal patients and 227 of the 240 pre-menopausal patients had TCT. At the same time, the indications for hysterectomy should be appropriately relaxed. [17] showed that the length of the cone removed from the post-menopausal patients was significantly longer than that removed from the pre-menopausal patients. They may pack your vagina with gauze. Call Your Healthcare Provider if You Have: Drink 8 to 12 (8-ounce) glasses of liquids. 2019;20(8):236572. Your doctor will use either a surgical knife or a laser to remove a cone-shaped piece of cervical tissue. For 4 to 6 weeks after your procedure or until your healthcare provider tells you your cervix is healed: Your next period may be late, or you may have a heavier blood flow than usual. This is call an endocervical curettage (ECC). J Cell Physiol. Caring for Yourself After Your Cone Biopsy of the Cervix, All rights owned and reserved by Memorial Sloan Kettering Cancer Center, 2023 Memorial Sloan Kettering Cancer Center, Human Oncology & Pathogenesis Program (HOPP), Gerstner Sloan Kettering Graduate School of Biomedical Sciences, High school & undergraduate summer programs. Your doctor will notify you of the results as soon as possible. 2012 May;119(6):678-84. doi: 10.1111/j.1471-0528.2012.03275, Fontham ETH, Wolf AMD, Church TR, et al. 7,752,060 and 8,719,052. Interventions for preventing blood loss during the treatment of cervical intraepithelial neoplasia. There was no significant difference between the 2 groups (28.57 vs. 33.33%, 2=0.285, P=0.593). Rock JA, Jones HW III (Eds.) The average follow-up period was 25 (range=643) months. Cone biopsy is an outpatient procedure, which means you dont stay overnight. -, Martin-Hirsch PP, Bryant A. Post-menopausal women usually have declining estrogen levels, atrophy of the cervix, and retraction of the SCJ.Thus, lesions are more often localized in the endocervix. A tube may be placed in your windpipe to protect and control breathing during general anesthesia. Get useful, helpful and relevant health + wellness information. Caring for yourself after your cone biopsy of the cervix. Unable to load your collection due to an error, Unable to load your delegates due to an error. If you have one cone biopsy and it is determined there are more cancer cells left behind, you may have a repeat procedure. You are often given only local anesthesia and you can return home much more quickly after the procedure. There are a few reasons why your healthcare provider may order a cone biopsy. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Cortisone Injections: What You Need to Know. Cytological analysis results revealed a 30.91% (34/110) diagnosis consistency between the cytology and biopsy histology in the post-menopausal women and 32.16% (73/227) in the pre-menopausal women. Call your healthcare providers office to schedule a follow-up visit. If you have questions about your care, contact your healthcare provider. The satisfactory rate of colposcopy was significantly lower in the post-menopausal group than in the pre-menopausal group (38.33 vs. 71.25%; 2=36.202, P<0.001). At an appointment prior to the surgery, your healthcare provider will explain the procedure and give you a chance to ask any questions. The procedure is usually performed if you had an abnormal Pap, Learn why an endometrial biopsy is done and what to expect during the procedure. Don't hesitate to ask them any questions you have before your procedure. BMC Surgery Your cervix may be packed with a pressure dressing. Follow your doctors advice for recovery. Youll recover at the hospital or surgical center for a few hours afterward. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. Kalogirou D, Antoniou G, Karakitsos P, et al. The upgrading between biopsy and conization was significantly higher in the post- than in the pre-menopausal group (11.67 vs. 5.42%, 2=4.505, P=0.03) (Tables 4 and 5). When there was inconsistency of pathological grade between colposcopy-directed biopsy, conization, and hysterectomy, the highest grade was the final diagnosis. Comprehensive Gynecology. Positive margin status in uterine cervix cone specimens is associated with persistent/recurrent high-grade dysplasia. Also, let your practitioner know about any allergies or if you have a bleeding disorder that can affect healing. The efficiency of detecting HSIL and higher lesions through cytological analysis and the HR-HPV DNA test does not differ between post- and pre-menopausal women. Cone biopsy of the cervix has been used for more than a century to rule out the presence of invasive carcinoma in women with squamous intraepithelial lesions (SIL). Sometimes all of the cancerous material can be removed during one cold knife cone biopsy. Contact your healthcare provider if you're still experiencing moderate to severe pain and bleeding after two weeks. (n.d.). Johnson N, Khalili M, Hirschowitz L, et al. Cai L, Huang Y, Lin C, Liu G, Mao X, Dong B, Lu T, Sun P. Transl Cancer Res. Alternately, they might place conventional surgical stitches in your cervix. Your doctor is unable to see or access abnormal cervical tissue with colposcopy. BMC Cancer. Shaco-Levy R, Eger G, Dreiher J, et al. 25 patients underwent colposcopy-directed biopsy. Reply. Conization of the cervix or cold knife cone (CKC) is a surgical procedure used to treat or diagnose cervical dysplasia. Moore BC, Higgins RV, Laurent SL, et al. If the patient survives, it may take up to two years before they are able to walk again. 1995;173:3618. The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. A cone biopsy, also called conization, is a surgical procedure that is used to remove a cone-shaped piece of tissue from the cervix and cervical canal. The pathologic margin of specimens from cold knife conization is less frequently involved and is easier to. 2023 BioMed Central Ltd unless otherwise stated. Regional anesthesia is also known as a nerve block. Gardeil F, Barry-Walsh C, Prendiville W, et al. 2015;55:3940. The .gov means its official. Some of the risks associated with cone biopsy are: Cone biopsy may cause scarring on your cervix. Among the 30 patients with positive margins, 26 cases were HSIL with resection margins, including 25 cases of CIN3 and 1 case of stage IA1 cervical cancer. However, the positive margins are a major problem. The patient with vaginal squamous cell carcinoma underwent chemotherapy. A CKC is used to remove pre-cancerous and, at times, cancerous cells from the cervix. Yan-Ming Jiang, Chang-Xian Chen, and Li Li . A cone biopsy (conization) is when surgeons remove a cone-shaped wedge of abnormal tissue from your cervix. In this study, we aimed to compare post-menopausal and pre-menopausal patients with HSIL who had undergone CKC and then evaluate the clinical significance of CKC in the diagnosis and surgery of HSIL in post-menopausal women. Your healthcare provider will monitor your blood pressure, pulse, bleeding and pain to ensure you're well enough to go home. Natural history of cervical intraepithelial neoplasia: a critical review. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://cancer.ca/en/treatments/tests-and-procedures/cone-biopsy), (https://www.cancerresearchuk.org/about-cancer/cervical-cancer/getting-diagnosed/tests-diagnose/cone-biopsy), (https://www.ncbi.nlm.nih.gov/books/NBK441845/). Prediction of residual neoplasia based on histopathology and margin status of conization specimens. Clinical symptoms occurred in 104 patients: abnormal vaginal bleeding (n=53, 22.08%), leukorrhagia (n=31, 12.92%), abnormal vaginal bleeding and leukorrhagia (n=16, 6.67%), or lumbosacral pain (n=4, 1.67%). However, it is not a standard treatment. PMC All rights reserved. The study sample included 120 post-menopausal and 240 pre-menopausal patients as controls (a ratio of 1:2). You and your healthcare provider will decide beforehand whether you should be given general anesthesia or medicines to help you relax and stay sleepy. As with all surgeries, a cone biopsy involves risks and complications. High Grade Squamous Intraepithelial Lesion Treatment. Cone biopsy is safe but comes with risks. J Obstet Gynaecol Res. You should be able to return to work two to three days after surgery. Lukic A, Iannaccio S, Di Properzio M, et al. 2013;41:14852. The site is secure. How should I contact you? The risks associated with cold knife cone biopsy are minimal. Cheng et al. Your healthcare provider will explain the short-term and long-term risks associated with the procedure, but it can be helpful to have an idea of what those might be so that you can be prepared to ask any specific questions. Kesic V, Dokic M, Atanackovic J, et al. These cells are called cervical intraepithelial neoplasia (CIN). Cold knife cone biopsies are usually performed as an outpatient procedure. If you're a patient at MSK and you need to reach a provider after. 50 patients had clinical symptoms: abnormal vaginal bleeding (n=31, 25.83%), leukorrhagia (n=8, 6.67%), abnormal vaginal bleeding and leukorrhagia (n=7, 5.83%), or lumbosacral pain (n=4, 3.33%). This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. Bookshelf Talk to your healthcare provider about the risks and benefits of the procedure to ensure you know what to expect. Find out how these treatments work, and what to expect. You might also need to stop taking heparin, warfarin, or other blood thinners. 14-type HPV mRNA test in triage of HPV DNA-positivepostmenopausalwomenwith normal cytology. Clin Exp Obstet Gynecol. For a cone biopsy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Bring sanitary pads with you to wear after the biopsy. You can learn more about how we ensure our content is accurate and current by reading our. An obstetrician-gynecologist (Ob-Gyn) commonly performs cone biopsy. Recent years have seen an increase in studies reporting CIN treatments with success rates exceeding 90%. Stopping smoking as soon as possible. LEEP and cold knife conization allow histologic review of the excised tissue, whereas ablative techniques destroy the transformation zone, precluding histologic evaluation. Cervical cancer can be prevented by early detection and proper treatment of HSIL. This information explains how to care for yourself after a cone biopsy of your cervix. 2003 Oct;102(4):726-30. Sixty-six women were randomly allocated to have the cone specimen removed by cold knife excision (n = 38) or loop excision (n = 28).Subjects eligible for inclusion were those who presented histologically verified grade 3 cervical intraepithelial neoplasia (CIN) or grade 2 CIN . It is important to keep your follow-up appointments after a cone biopsy. This kills the abnormal cells by freezing them. Am J Obstet Gynecol. It is not necessarily a sign of a surgical infection. The goal is to leave behind as much healthy tissue as possible to allow for regeneration of the cervical cells. A colposcope is a lighted magnifying glass that guides them to the area that needs to be removed. Well also tell you about any risks involved in the procedure and. Cervical diagnostic excisional procedures (also known as conization or cone biopsy) refer to the excision of a cone-shaped portion of the cervix surrounding the endocervical canal and including the entire transformation zone. Conization of the cervix or cold knife cone (CKC) is a surgical procedure used to treat or diagnose cervical dysplasia. Gynecol Oncol. Consequently, exhaustive long-term follow-up must be considered an integral part of CKC of HSIL after menopause. The requirement for informed consent was waived due to the retrospective study design. Patient information: Management of a cervical biopsy with precancerous cells, Deborah Weatherspoon, Ph.D, MSN, RN, CRNA, cancer.org/Cancer/CervicalCancer/DetailedGuide/cervical-cancer-diagnosis, ncbi.nlm.nih.gov/pmc/articles/PMC3097330/, mayoclinic.org/diseases-conditions/cervical-cancer/basics/tests-diagnosis/con-20030522, hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/cervical_biopsy_92,P07767/, uptodate.com/contents/management-of-a-cervical-biopsy-with-precancerous-cells-beyond-the-basics?source=see_link, Colposcopy-Directed Biopsy: Purpose, Procedure, and Risks, 10 Reasons for Hysterectomy, Plus Benefits and Side Effects. She is the former chief of obstetrics-gynecology at Yale Health. Memorial Sloan Kettering was founded in 1884, and today is a world leader in patient care, research, and educational programs. 2019 Feb;40(1):7-12. For low-grade abnormal cells, a PAP test may be recommended every year to two years. CAS What medications will I need before and after the surgery? Moreover, 49 post-menopausal patients underwent a second surgical treatment, of which 29 had positive margins and 20 had negative margins. In addition, if you have any sudden symptoms after the cone biopsy that seem alarming to you, it's important to contact your healthcare provider or seek urgent medical attention. (2015, January 31), Tests and Procedures - Cervical biopsy. Hysterectomy is sometimes selected as the primary treatment for post-menopausal patients with HSIL because they have no fertility requirement but are concerned about the persistence or progression of the disease. Copyright 2023, StatPearls Publishing LLC. Stages 0 and IA1 of cervical cancer are sometimes treated with cold knife cone biopsy. 2018 Dec;143(3):306-312. A colposcopy is a method of examining the cervix, vagina, and vulva with a colposcope. Johns Hopkins Medicine, Wright, J.D., (2016). In our study, the upgrading between biopsy and conization was significantly higher in the post- than in the pre-menopausal group (11.67% vs. 5.42%). The results demonstrated that the positive rate of HR-HPV was 91.07% (102/112) in the post-menopausal women and 94.20% (211/224) in the pre-menopausal women. California Privacy Statement, Cone biopsy Excision can also be done with a scalpel instead of a loop; this is called a cone biopsy or cold knife conization ( figure 1 ). CIN is classified on a scale of one to three depending on how much cervical tissue contains abnormal cells. Narrowing of your cervix (cervical stenosis). Your healthcare provider performs a cone biopsy when: Your provider may also offer a cone biopsy when other methods such as colposcopy or punch biopsy don't find the cause of abnormal cell changes. Does the cervix regenerate after a cone biopsy? Regeneration of uterine cervix at 6 months after large loop excision of the transformation zone for cervical intraepithelial neoplasia. Cone biopsy is only one method used to treat cervical abnormalities. The recurrence rate was 2.34%, which was identified 428months after the primary therapy. FOIA You will not feel or remember this or the surgery as they happen. 2020;20:34. In 1976, Kolstad and Klem reported on 1122 patients with carcinoma in situ treated with conization, with a recurrence rate of 2.3% and an unexpected discovery of small invasive carcinomas in 0.9%. Advertising on our site helps support our mission. 5 cases of resection margins were cancer, including 4 cases of stage IB1 and 1 case of stage IA2 cervical cancer, all underwent radical hysterectomy and pelvic lymphadenectomy.Moreover, 5 cases of cervical cancer of stage IA1 with negative margins, 6 cases with extensive lesions, and 2 cases with residual lesions underwent extrafascial hysterectomy. Your healthcare provider will give you a list of activities to avoid until your follow-up appointment. Management of adenocarcinoma in situ of the uterine cervix: a comparison of loop electrosurgical excision procedure and cold knife conization. Because chronic constipation can cause pain and bloating, it's understandable to seek quick constipation relief. Residual rate of positive and negative margins in patients before and after menopause was significantly different (2=5.711, P=0.017; 2=12.726, P<0.001, respectively). Gynecol Oncol. How might a cone biopsy affect my everyday life? Anesthesia is either given intravenously (through a needle into a vein) or through a mask. 2020;20:1025. In our study, the recurrence rates of HSIL after CKC were 3.85 and 2.34% in post- and pre-menopausal patients, respectively, consistent with that in previously published reports. This indicates that hysterectomy cannot reduce HSIL recurrence. The pooled meta-analysis exhibited significantly different outcome (RR, 1.55; 95% CI, 1.34-1.80, P<0.00001) without significant heterogeneity (P = 0.34). Interpretability of excisional biopsies of the cervix: cone biopsy and loop excision. Your doctor will perform a cone biopsy using either general anesthesia or regional anesthesia. Increasing age and severity of disease in the cone specimen were the only factors that accurately predicted residual dysplasia. Kim, M., Hahn, H., Lim, K., Lee, K., Kim, H., Hong, S., & Kim, T. (2011, March 31). Your feedback will help us improve the educational information we provide. Then, your provider sends the tissue to a laboratory for further testing. You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. Philadelphia: Lippincott Williams & Wilkins, 2008. This includes sexual intercourse, tampons, fingers and douching. The examination was classified as unsatisfactory if the entire cervical lesion and transformation zone were not visualized. Chen Y, Lu H, Wan X, et al. Your provider should have the results of your biopsy within about a week. Its the part of your uterus that dilates (opens) during childbirth. The nurse will perform an exam and ensure that all needed tests are in order. There will be discomfort after your surgery. Obstet Gynecol. Complications can develop during surgery, recovery or later. CKC has been the traditional procedure for CIN and is . Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: Systematic review and meta-analysis. Google Scholar. 16 of 120 and 27 of 240 patients in the post- and pre-menopausal groups, respectively, were lost to follow-up. Dont soak in water (such as swimming pools, hot tubs, or baths). This procedure is most commonly used for the removal of larger tumors and cysts, for biopsies of suspicious lesions, and for the extraction of childbirth membranes. Learn what to expect from each surgical approach and why internal, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 2014;33:838. This procedure removes a large cone-shaped piece of the cervix to look for precancerous cells, or cancerous material. and transmitted securely. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Please enable it to take advantage of the complete set of features! B., Nayar, R., Saraiya, M., Sawaya, G. F., Wentzensen, N., Schiffman, M., & 2019 ASCCP Risk-Based Management Consensus Guidelines Committee (2020). You wont feel any pain under either general or regional anesthesia. Hasegawa K, Torii Y, Kato R, et al. Endocervical margin status and severity of neoplasia significantly predicted the occurrence of persistent/recurrent disease after conization. Risks of general anesthesia can include: You may be given a regional anesthetic instead. Miroshnichenko GG, Parva M, Holtz DO, Klemens JA, Dunton CJ. The surgical team will monitor your vital signs and other critical body functions. This should be about 4 weeks after your procedure. Your doctor will tell you when and how to remove the packing. Int J Gynaecol Obstet. Your doctor can begin or change your treatment to help you manage depression. In most cases, cone biopsy is successful with no long-term side effects. Cold knife cone biopsy is a highly effective way of diagnosing abnormalities of the cervix and treating early stages of cervical cancer. Manage cookies/Do not sell my data we use in the preference centre. Follow-up until now, HPV and cytology are all negative. As one type of cervical conization surgery, CKC has been widely performed as a diagnostic and therapeutic procedure for patients with HSIL. It is a good idea to leave all jewelry and valuables at home or with a family member. It can also be helpful to reach out to someone else who's had a cone biopsy, but be selective. Asciutto K et al. These 10 tests and treatments are some of the top offenders. This is especially important if you have already been diagnosed with cervical precancer or cancer. Cold-knife conization can be performed as a primary procedure for diagnosis and surgery of post-menopausal patients with high-grade squamous intraepithelial lesions. https://doi.org/10.1097/LGT.0000000000000525, Perkins RB, Guido RS, Castle PE, et al. Full recovery takes about two weeks. It is common for patients to forget some of their questions during a doctors office visit. Seek urgent medical care if you experience any of the following symptoms after a cone biopsy:. It can detect cervical cancer or changes in some of the cells of your cervix, typically referred to as cervical dysplasia, that could lead to cervical cancer. Residual and recurrent disease after laser conization for cervical intraepithelial neoplasia. 2003;110:9525. [7] reported that the infection rate of HPV in post-menopausal women was 9.55%. Latif NA, Neubauer NL, Helenowski IB, Lurain JR. J Low Genit Tract Dis. J Low Genit Tract Dis. Eat well-balanced, healthy meals. Begin the procedure by placing either a posterior weighted speculum (for a cold-knife cone) or an insulated speculum (for electrocautery) into the vagina. You may also think of other questions after your appointment. The immediate treatment of HSIL (CIN2,3) is usually necessary, as the spontaneous regression rates at these stages are low (32%-43%); if such disease is left untreated, the risk of progression to invasive cancer is substantially increased by 522% [1, 2].Cervical conization, as a conservative surgical approach to treat HSIL, includes cold-knife conization (CKC), loop electrosurgical excision procedure (LEEP), and laser conization. Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III. You are unaware of the procedure and will not feel any pain. Submission of this form is subject to Healthgrades, Help Millions of people find the right doctor and care they need, Get immediate care and visit with providers from the comfort of your home, or anywhere, Urgent care centers can be faster and cheaper for situations that are not life threatening, Doctors and patients discuss the latest medical treatments and health tips, Search prescription drugs for why theyre used, side effects and more, Back and Neck Surgery (Except Spinal Fusion), http://www.dana-farber.org/Health-Library/Cervical-cone-biopsy.aspx, http://www.acog.org/~/media/For%20Patients/faq135.pdf?dmc=1&ts=20130830T1246282949, http://www.asccp.org/Portals/9/docs/pdfs/Patient_Education/Cone_Biopsy.pdf, http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-diagnosis. The chance that your procedure will be effective and without complications is higher than for someone who may have had the procedure in the distant past. A normal result means no precancerous or cancerous cells were found on your cervix. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. A normal result means there are no precancerous or cancerous cells in the cervix. In some cases, your surgeon will provide you with prescription pain medication, but typically, over-the-counter pain relievers work well. Article CKC can be performed as a primary procedure for diagnosis and treatment in post-menopausal patients with HSIL. Cold knife cone biopsy is performed under a general or regional anesthetic. Post-menopausal patients with positive cone margins had significantly higher chances of having a residual lesion than those with negative margins, similar to the pre-menopausal group. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Conization may also be used to treat high-grade cervical cell changes. Your healthcare provider will give you instructions on preparing for a cone biopsy. The study was supported by grants from the Beijing Medical Health Foundation (NO,YWJKJJHKYJJ-B182838) and Tianjin Science and Technology Committee Fund Project (NO.19YFZCSY00600). Needing to change a sanitary pad every two hours. Contact your doctor with concerns and questions before surgery. There was no significant difference between the 2 groups (2=0.164, P=0.686). Not eating or drinking before surgery as directed. Losing excess weight before the surgery through a healthy diet and exercise plan. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. A cone biopsy can also cause significant changes to your body that may affect your everyday life, such as: Difficulty interpreting abnormal Pap test results, Higher risk of pregnancy complications including infertility, miscarriage, and incompetent cervix. Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled non-inferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study. American Cancer Society. This ensures all abnormal cells are removed. You may have a sore throat if a tube was placed in your windpipe during surgery. Practitioners can use this procedure when there are a conflicting pap smear and biopsy specimen. Currently, the two main excisional strategies for CIN treatment are loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ) and cold-knife conization (CKC), which offers deep excision of the cervical transformation zone with minimal damage.