eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Gynecologic Cryosurgery: Workup

Author: E L Kristiina Parviainen, MD, Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh
Coauthor(s): Nancy D Gaba, MD, Residency Program Director, Assistant Professor, Department of Obstetrics and Gynecology, George Washington University School of Medicine
Contributor Information and Disclosures

Updated: May 12, 2008

Workup

Diagnostic Procedures

  • Colposcopy of the vagina and cervix is performed with the application of acetic acid.
  • Cervical punch biopsies and ECC are used selectively to confirm histologically the diagnosis of CIN. This also permits identification of the size, shape, and location of the dysplastic lesion.

Histologic Findings

For a detailed discussion of the histologic findings of CIN, the reader is referred to a text of gynecologic pathology such as Blaustein's Pathology of the Female Genital Tract, Fifth Edition21 .

More on Gynecologic Cryosurgery

Overview: Gynecologic Cryosurgery
Workup: Gynecologic Cryosurgery
Treatment: Gynecologic Cryosurgery
Follow-up: Gynecologic Cryosurgery
References
[ CLOSE WINDOW ]

References

  1. ACOG. ACOG Practice Bulletin number 66, September 2005. Management of abnormal cervical cytology and histology. Obstet Gynecol. Sep 2005;106(3):645-64.

  2. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114–9.

  3. Crisp WE, Smith MS, Asadourian LA. Cryosurgical treatment of premalignant disease of the uterine cervix. Am J Obstet Gynecol. Jul 1 1970;107(5):737-42. [Medline].

  4. Townsend DE, Ostergard DR. Cryocauterization for preinvasive cervical neoplasia. J Reprod Med. Apr 1971;6(4):171-6. [Medline].

  5. Ostor AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. Apr 1993;12(2):186-92. [Medline].

  6. Schlecht NF, Platt RW, Duarte-Franco E, Costa MC, Sobrinho JP, Prado JC. Human papillomavirus infection and time to progression and regression of cervical intraepithelial neoplasia. J Natl Cancer Inst. Sep 3 2003;95(17):1336-43. [Medline].

  7. Nobbenhuis MA, Helmerhorst TJ, van den Brule AJ, Rozendaal L, Voorhorst FJ, Bezemer PD. Cytological regression and clearance of high-risk human papillomavirus in women with an abnormal cervical smear. Lancet. Nov 24 2001;358(9295):1782-3. [Medline].

  8. Moscicki AB, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet. Nov 6-12 2004;364(9446):1678-83. [Medline].

  9. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA: A Cancer Journal for Clinicians. Jan-Feb 2007;57(1):43-66.

  10. Devesa SS. Descriptive epidemiology of cancer of the uterine cervix. Obstet Gynecol. May 1984;63(5):605-12.

  11. Schoell WM, Janicek MF, Mirhashemi R. Epidemiology and biology of cervical cancer. Semin Surg Oncol. Apr-May 1999;16(3):203-11. [Medline].

  12. Smith R. CA - A Cancer Journal for Clinicians. 51. Philadelphia, Pa: Lippincott, Williams, & Wilkins; 2001:18-44.

  13. Cirisano FD. Management of pre-invasive disease of the cervix. Semin Surg Oncol. Apr-May 1999;16(3):222-7. [Medline].

  14. Insinga RP, Glass AG, Rush BB. Diagnoses and outcomes in cervical cancer screening: a population-based study. Am J Obstet Gynecol. Jul 2004;191(1):105-13. [Medline].

  15. Richart RM. Natural history of cervical intraepithelial neoplasia. Clin Obstet Gynecol. 1968;10:748-784.

  16. Fu YS, Reagan JW, Richart RM. Definition of precursors. Gynecol Oncol. Oct 1981;12(2 Pt 2):S220-31. [Medline].

  17. Hollingsworth RE, Lee WH. Tumor suppressor genes: new prospects for cancer research. J Natl Cancer Inst. Jan 1991;83(2):91-6.

  18. Lorincz AT, Reid R, Jenson AB. Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. Obstet Gynecol. Mar 1992;79(3):328-37.

  19. Willett GD, Kurman RJ, Reid R. Correlation of the histologic appearance of intraepithelial neoplasia of the cervix with human papillomavirus types. Emphasis on low grade lesions including so-called flat condyloma. Int J Gynecol Pathol. 1989;8(1):18-25. [Medline].

  20. Charles EH, Savage EW, Hacker N. Cryosurgical treatment of cervical intraepithelial neoplasia. Gynecol Oncol. Aug 1981;12(1):83-8. [Medline].

  21. Precancerous Lesions of the Cervix. In: Kurman RJ. Blaustein's Pathology of the Female Genital Tract. 5th. New York: Springer-Verlag; 2002.

  22. Boonstra H, Aalders JG, Koudstaal J. Minimum extension and appropriate topographic position of tissue destruction for treatment of cervical intraepithelial neoplasia. Obstet Gynecol. Feb 1990;75(2):227-31. [Medline].

  23. Boonstra H, Koudstaal J, Oosterhuis JW. Analysis of cryolesions in the uterine cervix: application techniques, extension, and failures. Obstet Gynecol. Feb 1990;75(2):232-9. [Medline].

  24. Figge DC, Creasman WT. Cryotherapy in the treatment of cervical intraepithelial neoplasia. Obstet Gynecol. Sep 1983;62(3):353-8. [Medline].

  25. Campion Michael J. Preinvasive Disease. In: Jonathan S. berek and Neville F. Hacker. Practical Gynecologic Oncology. 4th. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:265-309.

  26. Creasman WT, Hinshaw WM, Clarke-Pearson DL. Cryosurgery in the management of cervical intraepithelial neoplasia. Obstet Gynecol. Feb 1984;63(2):145-9. [Medline].

  27. Popkin DR, Scali V, Ahmed MN. Cryosurgery for the treatment of cervical intraepithelial neoplasia. Am J Obstet Gynecol. Mar 1 1978;130(5):551-4. [Medline].

  28. Harper DM, Mayeaux EJ Jr, Daaleman TP. The natural history of cervical cryosurgical healing. The minimal effect of debridement of the cervical eschar. J Fam Pract. Aug 2000;49(8):694-700. [Medline].

  29. Weed JC Jr, Curry SL, Duncan ID. Fertility after cryosurgery of the cervix. Obstet Gynecol. Aug 1978;52(2):245-6. [Medline].

  30. Hemmingsson E, Stendahl U, Stenson S. Cryosurgical treatment of cervical intraepithelial neoplasia with follow-up of five to eight years. Am J Obstet Gynecol. Jan 15 1981;139(2):144-7. [Medline].

  31. Montz FJ. Impact of therapy for cervical intraepithelial neoplasia on fertility. Am J Obstet Gynecol. Oct 1996;175(4 Pt 2):1129-36. [Medline].

  32. Ferenczy A. Comparison of cryo- and carbon dioxide laser therapy for cervical intraepithelial neoplasia. Obstet Gynecol. Dec 1985;66(6):793-8. [Medline].

  33. Johnson VW, Homesley HD. Comparison of cryosurgery and carbon dioxide laser ablation for treatment of cervical intraepithelial neoplasia. Colposc Gynecol Laser Surg. 1984;173-180.

  34. Berget A, Andreasson B, Bock JE. Laser and cryo surgery for cervical intraepithelial neoplasia. A randomized trial with longterm follow-up. Acta Obstet Gynecol Scand. 1991;70(3):231-5. [Medline].

  35. Sparks RA, Scheid D, Loemker V, et al. Association of cervical cryotherapy with inadequate follow-up colposcopy. J Fam Pract. Jun 2002;51(6):526-9. [Medline].

  36. Schmidt C, Pretorius RG, Bonin M. Invasive cervical cancer following cryotherapy for cervical intraepithelial neoplasia or human papillomavirus infection. Obstet Gynecol. Nov 1992;80(5):797-800. [Medline].

  37. Ben-Arie A, Kogan S, Fink A. Anaphylactoid reaction after cryotherapy of the cervix. Obstet Gynecol. May 1999;93(5 Pt 2):841. [Medline].

  38. Benedet JL, Miller DM, Nickerson KG. The results of cryosurgical treatment of cervical intraepithelial neoplasia at one, five, and ten years. Am J Obstet Gynecol. Aug 1987;157(2):268-73. [Medline].

  39. Gordon HK, Duncan ID. Effective destruction of cervical intraepithelial neoplasia (CIN) 3 at 100 degrees C using the Semm cold coagulator: 14 years experience. Br J Obstet Gynaecol. Jan 1991;98(1):14-20. [Medline].

  40. Bryson SC, Lenehan P, Lickrish GM. The treatment of grade 3 cervical intraepithelial neoplasia with cryotherapy: an 11-year experience. Am J Obstet Gynecol. Jan 15 1985;151(2):201-6. [Medline].

  41. Ostergard DR. Cryosurgical treatment of cervical intraepithelial neoplasia. Obstet Gynecol. Aug 1980;56(2):231-3. [Medline].

  42. Mitchell MF, Tortolero-Luna G, Cook E. A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix. Obstet Gynecol. Nov 1998;92(5):737-44. [Medline].

  43. Nuovo J, Melnikow J, Willan AR. Treatment outcomes for squamous intraepithelial lesions. Int J Gynaecol Obstet. Jan 2000;68(1):25-33. [Medline].

  44. Kleinberg MJ, Straughn JM, Stringer JS, Partridge EE. A cost-effectiveness analysis of management strategies for cervical intraepithelial neoplasia grades 2 and 3. Am J Obstet Gynecol. May 2003;188(5):1186-8. [Medline].

  45. Skehan M, Soutter WP, Lim K. Reliability of colposcopy and directed punch biopsy. Br J Obstet Gynaecol. Sep 1990;97(9):811-6. [Medline].

  46. Andersen ES, Thorup K, Larsen G. The results of cryosurgery for cervical intraepithelial neoplasia. Gynecol Oncol. May 1988;30(1):21-5. [Medline].

  47. Barron BA, Richart RN. A statistical model of the natural history of cervical carcinoma based on a prospective study of 557 cases. J. Nat Cancer Inst. 1968;41:1343-53.

  48. Benedet JL, Miller DM, Nickerson KG. Results of conservative management of cervical intraepithelial neoplasia. Obstet Gynecol. Jan 1992;79(1):105-10. [Medline].

  49. Benedet JL, Nickerson KG, Anderson GH. Cryotherapy in the treatment of cervical intraepithelial neoplasia. Obstet Gynecol. Dec 1981;58(6):725-9. [Medline].

  50. Berget A, Andreasson B, Bock JE. Outpatient treatment of cervical intra-epithelial neoplasia. The CO2 laser versus cryotherapy, a randomized trial. Acta Obstet Gynecol Scand. 1987;66(6):531-6. [Medline].

  51. Crisp WE. Cryosurgical treatment of neoplasia of the uterine cervix. Obstet Gynecol. Apr 1972;39(4):495-9. [Medline].

  52. Dunton CJ. Cryotherapy: evidence-based interventions and informed consent. J Fam Pract. Aug 2000;49(8):707-8. [Medline].

  53. Hatch KD, Shingleton HM, Austin JM Jr. Cryosurgery of cervical intraepithelial neoplasia. Obstet Gynecol. Jun 1981;57(6):692-8. [Medline].

  54. Kalliala I, Anttila A, Pukkala E, Nieminen P. Risk of cervical and other cancers after treatment of cervical intraepithelial neoplasia: retrospective cohort study. BMJ. Nov 19 2005;331(7526):1183-5. [Medline].

  55. Kalliala I, Nieminen P, Dyba T, Pukkala E, Anttila A. Cancer free survival after CIN treatment: comparisons of treatment methods and histology. Gynecol Oncol. Apr 2007;105(1):228-33. [Medline].

  56. Kaufman RH, Irwin JF. The cryosurgical therapy of cervical intraepithelial neoplasia. III. Continuing follow-up. Am J Obstet Gynecol. Jun 15 1978;131(4):381-8. [Medline].

  57. Kirwan PH, Smith IR, Naftalin NJ. A study of cryosurgery and the CO2 laser in treatment of carcinoma in situ (CIN III) of the uterine cervix. Gynecol Oncol. Oct 1985;22(2):195-200. [Medline].

  58. Koutsky LA, Holmes KK, Critchlow CW. A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med. Oct 29 1992;327(18):1272-8. [Medline].

  59. Kwikkel HJ, Helmerhorst TJ, Bezemer PD. Laser or cryotherapy for cervical intraepithelial neoplasia: a randomized study to compare efficacy and side effects. Gynecol Oncol. Sep 1985;22(1):23-31. [Medline].

  60. Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet. Feb 11 2006;367(9509):489-98. [Medline].

  61. Martin-Hirsch PL, Paraskevaidis E, Kitchener H. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2000;(2):CD001318. [Medline].

  62. Montz FJ. Management of high-grade cervical intraepithelial neoplasia and low- grade squamous intraepithelial lesion and potential complications. Clin Obstet Gynecol. Jun 2000;43(2):394-409. [Medline].

  63. Munoz N, Bosch FX, de Sanjose S. The causal link between human papillomavirus and invasive cervical cancer: a population-based case-control study in Colombia and Spain. Int J Cancer. Nov 11 1992;52(5):743-9. [Medline].

  64. National Cancer Institute. The 1988 Bethesda System for reporting cervical/vaginal cytological diagnoses. National Cancer Institute Workshop. JAMA. Aug 18 1989;262(7):931-4. [Medline].

  65. Persad VL, Pierotic MA, Guijon FB. Management of cervical neoplasia: a 13-year experience with cryotherapy and laser. J Low Genit Tract Dis. Oct 2001;5(4):199-203. [Medline].

  66. Pinto AP, Crum CP. Natural history of cervical neoplasia: defining progression and its consequence. Clin Obstet Gynecol. Jun 2000;43(2):352-62. [Medline].

  67. Solomon D, Davey D, Kurman R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. Apr 24 2002;287(16):2114-9. [Medline].

  68. Soutter WP, Sasieni P, Panoskaltsis T. Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer. Apr 15 2006;118(8):2048-55. [Medline].

  69. Townsend DE, Richart RM. Cryotherapy and carbon dioxide laser management of cervical intraepithelial neoplasia: a controlled comparison. Obstet Gynecol. Jan 1983;61(1):75-8. [Medline].

  70. Wright TC Jr. HPV DNA testing for cervical cancer screening. FIGO 6th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. Nov 2006;95 Suppl 1:S239-46. [Medline].

  71. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. Oct 2007;197(4):346-55. [Medline].

  72. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol. Oct 2007;197(4):340-5. [Medline].

  73. Wright VC, Davies EM. The conservative management of cervical intraepithelial neoplasia: the use of cryosurgery and the carbon dioxide laser. Br J Obstet Gynaecol. Jun 1981;88(6):663-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

gynecologic cryosurgery, cryotherapy, cryocautery, gynecologic surgery, gynecological surgery, gynecologic cryotherapy, cervical intraepithelial neoplasia, CIN, Papanicolaou test, Pap test, Papanicolaou smear, Pap smear

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

E L Kristiina Parviainen, MD, Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh
E L Kristiina Parviainen, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Nancy D Gaba, MD, Residency Program Director, Assistant Professor, Department of Obstetrics and Gynecology, George Washington University School of Medicine
Nancy D Gaba, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, and Medical Society of the District of Columbia
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.