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1196 HPV positivity, abnormal pap smear and cervical stenosis: is diagnostic cervical excision necessary?
  1. Agnieszka Denecke1,
  2. Duaa Emar2,
  3. Peter Hillemanns1,
  4. Bianca Brüning3 and
  5. Matthias Jentschke1
  1. 1Hannover Medical School, Hannover, Germany
  2. 2Klinikum Wolfsburg, Wolfsburg, Germany
  3. 3Sociology Department, Hannover, Germany


Introduction/Background There is currently no algorithm for further clarification patients with HPV persistence and preoperative stenosis of the cervical canal, which has a significant impact on cytology, colposcopy and the possibility to obtain a reliable cervical histology. In our analysis colposcopy and cytology underestimated histologic findings in patients with limited visibility due to type 3 TC. We observed that colposcopy and cytology did not correlate significantly with histological findings and cytology and insufficient colposcopy underdiagnosed dysplastic lesions in patients with type 3 TC and cervical stenosis. In the case of repeated cytological abnormalities and inadequate colposcopic examination, histology sampling in form of diagnostic conization is very important to exclude high-grade dysplastic changes and cervical carcinoma.

Methodology We analysed retrospective 1.021 conizations between 2014 and 2020. Among these operative interventions, 89 were diagnostic conizations. The criteria for diagnostic conization in our analysis were HPV persistence and repeated cytologic abnormalities in combination with type 3 TC and the impossibility to retrieve a relevant cervical histology sample.

Results The percentage of diagnostic excisions in this period among all conizations was 8.7%.

We found histologic abnormalities in 48 of 89 patients (53.9%). Histological examination of the cone revealed high-grade cervical intraepithelial neoplasia (CIN 3) in 9 cases (10.1%) and CIN 2+ in 23 out of 89 cases (25.8%). In 2 cases early-stage cervical carcinoma (FIGO I, pT1a1 and pT1a2) was confirmed (2.3%).

Conclusion Patients with cervical stenosis, high-risk HPV persistence and repeated cytologic abnormalities have a high risk for undetected high-grade cervical dysplasia. Diagnostic excision is a valuable tool for the management of these patients.

Disclosures The authors have no conflicts of interest to declare.

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