Treatment of Cervical Dysplasia with the Fischer Cone Biopsy Excisor in a Family Medicine Office: A Case Series

The Journal of the American Board of Family Medicine

Elie Mulhem¹  David Lick¹  Elizabeth L. Kennedy¹ 

[1] From the Family Medicine Residency, William Beaumont Hospital, Troy, Michigan

关键词: Cervical Intraepithelial Neoplasia;    Fischer Cone Biopsy Excisor;    Loop Electrosurgical Excision Procedure;    Procedures;    Cancer Prevention and Control;    Pap Smears/Colposcopy;    Case Series;   

DOI  :  10.3122/jabfm.2010.02.090002

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: The purpose of this study was to evaluate the use of the Fischer cone biopsy excisor (FCBE) as the primary electrode for treatment of cervical dysplasia in a family medicine office.

Methods: Retrospective analysis of cervical electrosurgical excision procedures in patients with cervical intraepithelial neoplasia (CIN) performed in our Family Medicine Center between 2002 and 2005.

Results: We reviewed 91 cases. Indication for excision was ≥CIN II in 86.8% of the patients. In the FCBE group (n = 86), 95% of the specimen margins were negative for dysplasia, 90% had no reported thermal artifact, and 81% were submitted unfragmented. In the FCBE and the loop electrosurgical excision procedure (LEEP) group (n = 5), 4 of the 5 specimens’ margins were negative for dysplasia. Reported complications included palpitations or flushing during cervical block (32%), pain (9%), and heavy bleeding (3%).

Conclusion: In this case series the use of the FCBE with or without the LEEP in a family medicine office provided a high rate of negative margins for dysplasia and a low rate of fragmentation and thermal artifact. Family physicians who perform LEEP can also use the FCBE safely in their offices to treat cervical dysplasia.

• Cervical Intraepithelial Neoplasia
• Fischer Cone Biopsy Excisor
• Loop Electrosurgical Excision Procedure
• Procedures
• Cancer Prevention and Control
• Pap Smears/Colposcopy
• Case Series

Treatment of cervical dysplasia in an outpatient setting involves either electrosurgical excision or cryotherapy of the cervical transformation zone. Two electrosurgical excision methods are most commonly used: the loop electrosurgical excision procedure (LEEP) and the Fischer cone biopsy excisor (FCBE). The LEEP was introduced in 1989,¹ followed by the FCBE in 1994.² Disadvantages of the LEEP include residual dysplasia at the margins of the specimen, thermal artifact, and fragmentation of the specimen.^3–6 These factors can increase the risk of recurrence of dysplasia after excision and can negatively affect the ability of the pathologist to evaluate the specimen.^7–10

The FCBE was designed to minimize the disadvantages of the LEEP by increasing the support and stabilization of the excising stainless steel wire. The FCBE consists of a straight stainless steel electrode attached to an insulated shaft and stop arm. After activation the electrode is inserted into the cervix until the stop arm touches the cervix. The shaft is rotated 360 degrees and a cone shaped cervical specimen is cut. Seven sizes of the wire are available, with different lengths and widths.^2,11

Many articles describe family physicians’ experience with the use of LEEP to treat cervical dysplasia.^12–15 However, there is currently no published article that describes the use of the FCBE for this purpose in a family medicine office.

In this study we evaluated the use of the FCBE in a family medicine office for the treatment of cervical dysplasia. To evaluate its effectiveness we documented rates of dysplasia at the tissue margins, fragmentation of the specimen, thermal damage, and procedure complications. In addition, for patients in whom the dysplasia was very large and we visualized residual Lugol negative epithelium after the use of the FCBE, the LEEP was used to remove these areas. We hypothesized that by doing so we will decrease the incidence of residual dysplasia in these cases.

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