Conization of Cervix (Cold Knife Conization)
Norm of Conization of Cervix (Cold Knife Conization)
Negative. No abnormal findings.
Usage of Conization of Cervix (Cold Knife Conization)
Follow-up study for abnormal Pap smear; atypical squamous cells of undetermined significance (ASCUS); carcinoma in situ; cervical cancer, cervical intraepithelial neoplasia (CIN); used when colposcopy, cervical cytology, and colposcopy biopsies yield inconclusive findings.
Description of Conization of Cervix (Cold Knife Conization)
Conization is a biopsy of the uterine cervix that is performed after cervical smears reveal the presence of intraepithelial neoplasias. It may be performed with dilation and curettage. The advantage that conization brings to the diagnostic process is that it provides a sample of the entire lateral margins of the transformation zone of the cervix. Cold knife conization is less expensive than laser conization and produces equally satisfactory specimens for histologic examination. The cold knife method may also be superior to the loop electrosurgical excisional procedure (LEEP) because it does not produce electrocautery artifact that interferes with examination of the cervical margins.
Professional Considerations of Conization of Cervix (Cold Knife Conization)
Consent form IS required.
Risks
Hemorrhage, infection, sepsis.
Contraindications
Anticoagulant therapy, bleeding disorders, thrombocytopenia. Sedatives are contraindicated in clients with central nervous system depression.
Preparation
- See Client and Family Teaching.
- Preschedule this test with the pathology laboratory. Biopsy specimens must be processed immediately.
- Obtain Lugol's solution, a tenaculum, vasopressin, conization knife, suture material, Gelfoam or Surgicel (or electrocautery), and a sterile container.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
Procedure
- This procedure can be performed under general anesthesia, though local anesthesia is less costly and the client experiences little discomfort, nausea, or vomiting.
- The client is placed in a lithotomy position, and the cervix is painted with Lugol's solution (Schiller's test) to detect white, pale, or unstained areas, which may indicate lesions.
- A suture may be sewn on each side of the cervix to control bleeding. The anterior lip of the cervix is lifted with a tenaculum, and vasopressin (Pitressin Synthetic) is injected into several areas to control bleeding.
- A cone of tissue is removed from the cervical os with a cold knife (Fleming knife). Tissues that did not stain with Schiller's test are included in the cone. The specimen is transferred immediately to the laboratory in a sterile container, with or without sterile saline, according to the requirements of the laboratory performing the test.
- Bleeding may be controlled by packing with Gelfoam or Surgicel or by cervical sutures or electrocautery.
Postprocedure Care
- Provide sanitary pads and observe for heavy bleeding, which is abnormal.
- Perform standard postanesthesia observations and assessments if general anesthesia or deep sedation was used.
Client and Family Teaching
- If general anesthesia will be used, fast from food and fluids for 8 hours before the procedure.
- A greenish-grayish discharge from the vagina caused by the presence of the Lugol's solution is normal for several days after the test.
- Resume previous diet after the procedure.
Factors That Affect Results
- Electrocautery should not be used because it distorts tissues and impairs diagnosis.
Other Data
- Conization should be performed in a hospital, rather than in a physician's office.
- Conization should be performed before dilation and curettage, which dislodges the cervical epithelium.
- Residual dysplasia present in cold knife conization specimens is not predictive of residual dysplasia in hysterectomy specimens.
- Residual carcinoma in situ can be present even with a negative conization margin.
