{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T16:32:08Z","timestamp":1773073928263,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The objective of this research is to evaluate cervical regeneration after large loop excision of the transformation zone (LLETZ) through the identification of a new sonographic reference point at the level of the uterine margins. In the period March 2021\u2013January 2022, a total of 42 patients affected by CIN 2\u20133 were treated with LLETZ at the University Hospital of Bari (Italy). Before performing LLETZ, cervical length and volume were measured with trans-vaginal 3D ultrasound. From the multiplanar images, the cervical volume was obtained using the Virtual Organ Computer-aided AnaLysis (VOCAL\u2122) program with manual contour mode. The line that connects the points where the common trunk of the uterine arteries reaches the uterus splitting into the ascending major branch and the cervical branch was considered as the upper limit of the cervical canal. From the acquired 3D volume, the length and the volume of the cervix were measured between this line and the external uterine os. Immediately after LLETZ, the removed cone was measured using Vernier\u2019s caliper, and before fixation in formalin, the volume of the excised tissue was evaluated by the fluid displacement technique based on the Archimedes principle. The proportion of excised cervical volume was 25.50 \u00b1 17.43%. The volume and the height of the excised cone were 1.61 \u00b1 0.82 mL and 9.65 \u00b1 2.49 mm corresponding to 14.74 \u00b1 11.91% and 36.26 \u00b1 15.49% of baseline values, respectively. The volume and length of the residual cervix were also assessed using 3D ultrasound up to the sixth month after excision. At 6 weeks, about 50% of cases reported an unchanged or lower cervical volume compared to the baseline pre-LLETZ values. The average percentage of volume regeneration in examined patients was equal to 9.77 \u00b1 55.33%. In the same period, the cervical length regeneration rate was 69.41 \u00b1 14.8%. Three months after LLETZ, a volume regeneration rate of 41.36 \u00b1 28.31% was found. For the length, an average regeneration rate of 82.48 \u00b1 15.25% was calculated. Finally, at 6 months, the percentage of regeneration of the excised volume was 90.99 \u00b1 34.91%. The regrowth percentage of the cervical length was 91.07 \u00b1 8.03%. The cervix measurement technique that we have proposed has the advantage of identifying an unequivocal reference point in 3D cervical measurement. Ultrasound 3D evaluation could be useful in the clinical practice to evaluate the cervical tissue deficit and express the \u201cpotential of cervical regeneration\u201d as well as provide the surgeon useful information about the cervical length.<\/jats:p>","DOI":"10.3390\/diagnostics13040791","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T05:57:52Z","timestamp":1676872672000},"page":"791","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Ultrasound Control of Cervical Regeneration after Large Loop Excision of the Transformation Zone: Results of an Innovative Measurement Technique"],"prefix":"10.3390","volume":"13","author":[{"given":"Vincenzo","family":"Pinto","sequence":"first","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3522-4648","authenticated-orcid":false,"given":"Miriam","family":"Dellino","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7193-2858","authenticated-orcid":false,"given":"Carla Mariaflavia","family":"Santarsiero","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-372X","authenticated-orcid":false,"given":"Gennaro","family":"Cormio","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology IRCCS Istituto Tumori \u201cGiovanni Paolo II\u201d Bari, 70124 Bari, Italy"},{"name":"Department of Interdiscipliniary Medicine (DIM), University of Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-6421","authenticated-orcid":false,"given":"Vera","family":"Loizzi","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology IRCCS Istituto Tumori \u201cGiovanni Paolo II\u201d Bari, 70124 Bari, Italy"},{"name":"Department of Interdiscipliniary Medicine (DIM), University of Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5736-9170","authenticated-orcid":false,"given":"Valentina","family":"Griseta","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9862-1619","authenticated-orcid":false,"given":"Antonella","family":"Vimercati","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0325-4316","authenticated-orcid":false,"given":"Gerardo","family":"Cazzato","sequence":"additional","affiliation":[{"name":"Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian, Area (DiMePRe-J), School of Medicine, Aldo Moro University of Bari, 70100 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1287-4285","authenticated-orcid":false,"given":"Eliano","family":"Cascardi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"},{"name":"Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2390-4582","authenticated-orcid":false,"given":"Ettore","family":"Cicinelli","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1365-2303.2008.00636.x","article-title":"European 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