PATERNOSTRO Chiara

Risk adapted optimization of large loop excision of the transformation zone

The aim of this project is to evaluate the possibilities of optimizing the excisional treatment for cervical neoplasia particularly in women wishing to conceive and furthermore investigate the clinical role and diagnostic accuracy of the endocervical curettage at the time of the excisional procedure. The most common used surgical procedure in this specific condition is a large loop excision of the transformation zone, i.e. LLETZ, in which the affected cervical tissue with suspected intraepithelial dysplasia is removed with an electrosurgical loop. As previous studies have shown, an elevated risk for adverse pregnancy events, which augments with the excision length of the removed tissues (i.e. cervical cone), has been described. In order to minimize the risk of adverse pregnancy events, excision size of the cervical cone needs to be defined carefully to remove as much as necessary but as less as possible cervical tissue. 

Therefore, weighing up the risk of undertreatment, with subsequent measures and even potential progression to cervical cancer, against the occurrence of adverse pregnancy events is crucial for individual management. According to the preoperative histological biopsy result, the transformation zone type, the HPV status as well as status of family planning the precise excision size should be planned. 

Therefore, the main objectives of the PHD project are

(i) evaluate the rate of specimens with clear endocervical margins according to the cervical excision length as well as HPV status and transformation zone type

(ii) evaluate the rate of specimens removed without further oncological benefit

(iii) evaluate the rate of histological adequate specimens of endocervical curettage and the impact on follow-up recommendations

Methods and Skills:

Clinical studies

Publications:

(selection)

Paternostro C, Joura EA, Ranftl C, Langthaler EM, Ristl R, Dorritke T, Pils S. Rate of involved endocervical margins according to high-risk human papillomavirus subtype and transformation zone type in specimens with cone length ≤ 10 mm versus > 10 mm - A retrospective analysis. Life (Basel) 13: 1775, 2023 

Paternostro C, Springer S, Kasprian G, Yerlikaya-Schatten G, Reischer T. Clinical course and outcome of prenatally detected 22q11.2 deletion syndrome - a retrospective analysis. Diagnostics (Basel) 13: 2244, 2023

Montanari E, Grimm C, Schwameis R, Kuessel L, Polterauer S, Paternostro C, Husslein H. Influence of training level on cervical cone size and resection margin status at conization: a retrospective study. Arch Gynecol Obstet. 297: 1517-1523, 2018