Abstract
Objective: To clarify whether pregnant women with uterine cervical intraepithelial neoplasia (CIN) III can be followed-up until delivery or conization during pregnancy is necessary.
Patients and Methods: We analyzed 9 pregnant patients with CIN III who were treated at the Saitama Cancer Center between 1992 and 1998. At the time of their first visit, every pregnant patient was examined by cytology, colposcopy, and directed punch biopsy. These combined methods were performed during pregnancy and after delivery in patients who wanted to be managed without conization. Conization and vaporization were performed using a YAG laser.
Results: Seven patients were managed without conization during their pregnancy. After delivery, 5 patients received conization and 2 patients received a total abdominal hysterectomy (TAH). Among these 7 patients, the clinical and cytohistological findings of all the cervices were persistent and no microinvasive carcinomas were found during the operative procedures after delivery. All of the patients had normal vaginal deliveries. Conization was performed during pregnancy in two patients. One of these patients had severe dysplasia (SD) and the other was diagnosed as having an adenocarcinomatous lesion on the basis of the biopsy specimen obtained at the time of the first visit.
Conclusion: Pregnant patients with CIN III can be safely followed-up using a combination of diagnostic techniques (cytology, colposcopy and biopsy) until and after delivery. However, when the cytohistological diagnosis during pregnancy is suspicious of cervical adenocarcinoma, further clinical evidence must be obtained before a decision regarding the need for conization can be made.
