eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Carbon Dioxide Laser Surgery for Cervical Dysplasia: Workup

Author: Janice L Bacon, MD, Professor and Chair, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine
Contributor Information and Disclosures

Updated: Dec 5, 2007

Workup

Laboratory Studies

  • The Papanicolaou test is the initial screening test for cervical cytologic abnormalities. It is a cost-effective cancer detection tool. Population screening has clearly led to a decline in the incidence of cervical carcinoma. However, by definition, it is a screening tool with a specificity of 98% and a sensitivity of 51%.9
    • The specimen is obtained with an appropriate collection device (brush combined with spatula, or broom with or without spatula). The specimens are representative of the entire transformation zone.
    • The samples obtained may be smeared on a glass slide and sprayed with cell fixative or placed in a liquid-based medium for later cell preparation. The liquid-based evaluation technique may allow the sample to be used for more than cytologic testing. Additional studies that can be performed on the sample may include HPV typing or gonorrhea or chlamydia detection.
  • Additional preoperative laboratory evaluations may be performed to ensure patient safety during anticipated anesthesia, especially in patients with a complex medical history (eg, cardiovascular disease, hypertension, diabetes).

Other Tests

HPV typing is often discussed as a possible adjunctive test in the evaluation of cervical cytologic abnormalities.

The most widely available commercial test is a polymerase chain reaction assay, but future studies may incorporate genotyping of HPV.

The 2006 ASCCP Consensus Guidelines recommend use of high-risk HPV testing in the evaluation of women with the following findings:

  1. Initial triage of women with ASCUS as an alternative to repeat cytology or colposcopy
  2. Women with ASC-H or LSIL cervical cytology tested 12 months after a colposcopic examination revealing no CIN 2 or CIN 3 (This recommendation includes pregnant women.) 
  3. Initial evaluation of females with atypical glandular cells performed at the time of colposcopy with endocervical sampling

In 2003, the FDA approved the use of HPV typing as an adjunct to cervical cytologic screening in women aged 30 years or older. It may enhance the sensitivity to cytologic screening. Only high-risk HPV typing is useful in the management of cytologic abnormalities. HPV typing should not be used for screening in women younger than age 30. 

Diagnostic Procedures

  • Prior to instituting therapy, results from cytology, colposcopic examination of the cervical transformation zone, and indicated biopsies must ensure that malignancy is not present.
  • The full extent of the lesion must be visible and within the planned area of ablation or excision.
  • If all of these criteria are not present, an excisional procedure may be preferable.
  • As an alternative, some lesions managed by ablative treatments using the carbon dioxide laser may be considered for treatment using cryotherapy or loop electroexcision.
  • Lesions considered for excision by laser conization alternatively may be considered for a LEEP or a cold-knife conization procedure.

More on Carbon Dioxide Laser Surgery for Cervical Dysplasia

Overview: Carbon Dioxide Laser Surgery for Cervical Dysplasia
Workup: Carbon Dioxide Laser Surgery for Cervical Dysplasia
Treatment: Carbon Dioxide Laser Surgery for Cervical Dysplasia
Follow-up: Carbon Dioxide Laser Surgery for Cervical Dysplasia
References
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References

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  3. Dorsey JH, Diggs ES. Microsurgical conization of the cervix by carbon dioxide laser. Obstet Gynecol. Nov 1979;54(5):565-70. [Medline].

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  10. Baggish MS. Basic and Advanced Laser Surgery in Gynecology. 2nd ed. Norwalk, Conn: Appleton & Lange; 1985:207-16.

  11. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin number 66, September 2005. Management of abnormal cervical cytology and histology. Obstet Gynecol. Sep 2005;106(3):645-64. [Medline].

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Further Reading

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Keywords

CO2 laser surgery, laser surgery, cervical intraepithelial neoplasia, CIN, human papilloma virus, HPV, squamous cervical abnormality, squamous carcinoma, squamous cell cancer, squamous intraepithelial lesion, SIL, cervical neoplasia, cervical cancer, cervical malignancy, atypical squamous cells of undetermined significance, ASCUS, cervical atypia, squamous atypias

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Contributor Information and Disclosures

Author

Janice L Bacon, MD, Professor and Chair, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine
Janice L Bacon, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Association of Reproductive Health Professionals, North American Society for Pediatric and Adolescent Gynecology, and South Carolina Medical Association
Disclosure: Organon Pharmaceuticals Honoraria Speaking and teaching; Merck & Company Honoraria Speaking and teaching

Medical Editor

Karen Loeb Lifford, MD, Director of General Gynecology, Associate Program Director, Department of Obstetrics and Gynecology, Instructor, Brigham and Women's Hospital, Harvard Medical School
Karen Loeb Lifford, MD is a member of the following medical societies: Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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