Cone biopsy before hysterectomy

Cone biopsy before hysterectomy

Cone biopsy before hysterectomy. Apr 16, 2023 · But before doing a hysterectomy, a biopsy must be done with a procedure called LEEP or cone, which removes a part of the cervix for examination. My 6 month follow up showed no HPV and all the bad cells were removed. The cone can confirm the diagnosis and the extent of the lesion, and Nov 29, 2022 · Cervical diagnostic excisional procedures (also known as conization or cone biopsy) refer to the excision of a cone-shaped portion of the cervix surrounding the endocervical canal and including the entire transformation zone. The site is secure. 3 Reactions. 8% vs. 2. Even among those for whom a hysterectomy is the proposed 'definitive treatment', a second cone biopsy may be required before hysterectomy to avoid Pre-Cancer: deeper cone biopsy or hysterectomy Cancer Concerns - GYN HYSTERECTOMY. I'm losing my uterous because the cone biopsy caused my cervix to seal shut with scar tissue. Methods underwent open surgery with prior cone biopsy (reference) (HR 1. Has anyone here had that first? Curious what to expect? After results, I’ll have a hysterectomy, online says 5 days recovery for wfh, does this sound right? I’m sure these are answered elsewhere but I’m struggling and finding all sorts of different information. Randy Dotinga is a freelance medical and science journalist based in San Diego Nov 17, 2021 · A cervical biopsy is a procedure in which a small sample of tissue is removed from the cervix and the cells are examined under a microscope for abnormalities. There were no patients with completely resected tumor after cone biopsy that developed a recur-rence. 80 (1); 1959 Jan 1. While some cases of HPV infection disappear spontaneously, most persist. But what I can tell you is that I also had a LEEP before my hysterectomy. Nov 3, 2022 · The patients were stratified by the type of preoperative diagnosis performed: cervical biopsy or cervical conization (either cold knife cone or loop electrosurgical excision procedure). Mar 18, 2024 · Adverse events of grade 3 or higher occurred in 5% of the hysterectomy patients and none of the cone-biopsy patients. trachelectomy. That said, when a colpo biopsy shows AIS, often a cone is the first step. Before sharing sensitive information, make sure you’re on a federal government site. Jul 21, 2021 · Fig. This Your provider will remove a small, cone-shaped piece of your cervical tissue using a scalpel (surgical knife) or a laser. Gynecol. Hysterectomy is the preferred treatment, but people who are still planning to become pregnant in the Oct 26, 2023 · Cervical conization is an excisional surgical procedure used to diagnose cervical dysplasia; it may also be therapeutic in some patients. 35, 95% confidence interval (CI) 0. 06). 6%) underwent prior conization before radical hysterectomy and 733 (63. 76, p=0. Abnormal changes in the cells on the surface of the cervix is called cervical dysplasia. Jul 1, 2023 · Association of preoperative cone biopsy with recurrences after radical hysterectomy Arch. It forms a canal that opens into the vagina. Baldwin. The type of operation you have will depend on several things Jan 22, 2019 · LEEP is safe and effective. By the way mine were not cancerous they were just fibroids like my doctor expected. Some pathologists in the community setting are unable to offer frozen-section processing of cone biopsy specimens on a routine basis because it is time consuming and labor intensive, often requiring preparation of >20 slides to allow valid interpretation. Endometrial biopsy: An endometrial biopsy is performed to determine the cause of abnormal uterine bleeding. A cone biopsy may be used to treat stage 1A1 cervical cancer in women who want to become pregnant. And the cells that are there are adino carcinoma, the kind that once they become cancer spread fast. It is critical to establish the depth and width of invasion to delineate microscopic stage IA1, IA2, and IB1 in order to execute the correct surgical procedure (extrafascial hysterectomy, modified radical hysterectomy, and type III radical A cone biopsy is also called conization. 6%, p=0. # 7. No lesion or inflammatory change on conization margins was considered negative. Conization, or cone biopsy, removes a cone-shaped portion of the cervix, encompassing the transformation zone and suspicious cervical lesions, for subsequent histological analysis. hysterectomy after conization. To examine the changes before and after non-radical surgical treatment (simple hysterectomy or cone biopsy [fertility preservation] and pelvic lymphadenectomy) on functional outcomes of bladder, bowel, and sexual function for stage IA1 (lymphatic vessel invasion positive [LVSI+]) and IA2-IB1 (=< 2 cm) carcinoma of the cervix. If the edges of the biopsy have cancer cells present, a repeat cone biopsy or a radical hysterectomy with removal of the pelvic lymph nodes might be an option. 1007/s00404-021-06145-0 View in Scopus Google Scholar It progressed to precancerous cells, but I wanted to have another baby so I opted for cone biopsy in 2020. Journal List. Mar 17, 2021 · Adenocarcinoma in situ (AIS) is an HPV-associated precancerous lesion of the glandular cells of the endocervix and the precursor to endocervical adenocarcinoma. 1-4 When May 13, 2022 · Cone biopsy of the cervix is essential for the surgical planning for microscopic disease management. In multivariate regression analysis, preoperative cone biopsy was the only factor significantly associated After a cone biopsy there is a slightly higher risk of miscarriage and premature birth, as well as complications if the baby is very premature. This tissue will be sent to the lab to be evaluated for signs of cancer. The cervix is the lower, narrow part of the uterus. Learn about If the 10. Nov 5, 2007 · If the abnormal Pap persists, the entire abnormal region of the cervix can be removed in a procedure called a cone biopsy. It is used as part of the diagnosis and treatment for abnormal or cancerous conditions. May 19, 2022 · Colposcopy is a diagnostic procedure that allows your provider to check your cervix (lower part of your uterus) and the wall of your vagina for abnormal tissue. They may see hysterectomy as an option to avoid this close surveillance and to be free of their dysplasia. Your provider may prescribe LEEP if a Pap test and colposcopy find abnormal cell growths. Kaplan–Meier survival curves on RFS for all patients and subgroups after laparoscopic or open radical hysterectomy analyzed for preoperative cone biopsy and tumor size < 2 cm. Today I had my follow up appt and waiting for results but doctor recommended a hysterectomy but leaving the ovaries for preventative measures. Jan 3, 2009 · The bad news was on a scale of one being the best possible scenario and 10 being the worst, I was a 9. 67). There are a few ways the doctor can remove the tissue. If the bleeding is caused by a cancer, a gyn oncologist will do the surgery, but if the In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death. In my case, one of the reasons was to confirm the severity of dysplasia so my doctor would know May 4, 2015 · In general, the standard recommendation for squamous carcinoma in situ is a cone biopsy, and the standard recommendation for adenocarcinoma in situ is hysterectomy if the woman in done having children. +1-410-502-7683 International. This procedure involves cutting away a cone-shaped piece of cervical tissue and leaving the rest of the cervix intact. Hysterectomy is commonly requested by patients upon learning of cervical dysplasia, particularly if they have chronic human papillomavirus (HPV) infection and have experienced years of frequent surveillance and interventions. I’ve got a cone biopsy this week and of course not looking forward to it. Other potential complications include reaction to the anesthesia, infection of the biopsy site, injury to the uterus or other tissues, cervical stenosis (when the cervical canal narrows or becomes closed), and failure to remove all cancerous tissue. Surgery is the main treatment for stage 1 cervical cancer. 007 Sep 23, 2023 · A cervical cone biopsy is a surgical procedure that extracts a cone or wedge-shaped piece of tissue from your cervix. Aug 13, 2015 · Re: Why cone biopsy before hysterectomy? The main reason is to determine whether or not to perform a routine hysterectomy versus a more extensive radical hysterectomy. Mar 16, 2022 · There is some pretty good evidence that cone biopsy with close follow up can be a good treatment and the risk of recurrence is not hugely different. Learn about reasons for the procedure, risks, and what to expect. [1] The procedure is considered therapeutic and diagnostic if all cervical Cone Biopsy and Hysterectomy - PMC. Patients with cervical cancer stage IA1 with LVSI to IIA2 and squamous, adenosquamous and adenocarcinoma subtype were included. The first 4 days after your procedure, you may have vaginal discharge that looks like menstrual bleeding. I had one and it found polyps that the ultrasound and MRI both missed. These are: large loop excision of transformation zone (LLETZ) cone biopsy. These include: infection. This can be very distressing to think about. As a library, NLM provides access to scientific literature. I am in no way advising you to have a hysterectomy. 349 and HR 2. 5. knife called a scalpel. 4%) underwent radical hysterectomy without previous cervical conization. The procedure takes about 20 minutes, and the full recovery time is about four weeks. A cone biopsy (conization) is surgery to remove a sample of abnormal tissue from the cervix. ) Feb 20, 2020 · A surgical knife or a laser knife will be used to remove a cone-shaped sample of cervical tissue. Sep 29, 2023 · Upcoming hysterectomy 3/20: Cone Biopsy the day before surgery — why? Cancer Concerns - GYN A LEEP (loop electrosurgical excision procedure) allows your provider to remove abnormal tissue on the surface of your cervix and, if necessary, test it for cancer. Hysterectomy is the surgical removal of the uterus. Aug 25, 2022 · Cone biopsy (eg, cold knife cone), cryosurgery, laser surgery, or loop electrocautery (eg, LEEP or LLETZ) are usually used to treat women with high-grade cervical intraepithelial neoplasia or carcinoma in situ of the cervix. Still, there are some risks. It can also be used as a treatment since it can sometimes completely remove pre-cancers and some very early cancers. My gynecologist told me that I would have a cone biopsy for two reasons: partly to remove the early cancer cells and partly to determine the extent of the cancer cells up into the cervical canal. If too much tissue is removed during a cone biopsy so that the internal opening of the cervix to Apr 27, 2022 · The primary objectives of the management of the patient with a histological high-grade squamous intraepithelial lesion (HSIL) (cervical intraepithelial neoplasia, CIN 2–3) are to eliminate the cervical cancer precursors and to identify occult micro-invasive or invasive carcinoma early on, thus reducing mortality from cervical cancer. A cone height of at least 10 mm was required for each patient. Advanced Search. It is also sometimes used to treat small stage 2A cancers. 0%, no cone biopsy: 86. Conclusions In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death. During an Mar 17, 2021 · Our findings showed firstly that previous cone biopsy before radical hysterectomy is the most predictive independent variable after meticulously matching the groups. W. The procedure can be done in different ways: Using a surgical blade (cold knife cone biopsy) Using a laser beam (laser conization) Nov 12, 2018 · Cancer screening: An endometrial biopsy is done prior to a hysterectomy in women with abnormal uterine bleeding to evaluate for endometrial cancer. The biopsy hurt bad for a few seconds and was fine after that. This community is sponsored by the National Cervical Cancer Coalition, an Inspire trusted partner. It doesn't happen often, but it did to me, so make sure you get a 2nd opinion and your doctor is very good at this proceedure. 106 respectively). The blood vessels and structures supporting the uterus will be detached, and the uterus is removed through the incision. 49 to 7. Learn about hysterectomy types and diagnosis. A cone biopsy removes a cone-shaped piece of tissue from the cervix. I then had to have a D&C to check the polyps before my hysterectomy was scheduled. Nov 16, 2020 · A cone-shaped portion of the cervix was excised to remove the cervical lesion and the entire transformation zone. An endometrial biopsy is used to screen for abnormal cells in the uterus. , 2015). The primary objectives are to determine the Feb 1, 2022 · In the first 24 hours after your procedure: Drink 8 to 12 (8-ounce) glasses of liquids. 16 to 0. The size of the tissue sample required is a deciding factor when considering cervical cone biopsy vs. The Dr is now saying he cannot do a hysterectomy for 6, preferably 8 weeks May 13, 2022 · Cone biopsy of the cervix is essential for the surgical planning for microscopic disease management. TTR time to recurrence, RFS recurrence-free survival. Of these patients, 423 (36. Jul 23, 2018 · For patients with cervical intraepithelial neoplasia stage I lesions, hysterectomy is not appropriate, as these patients have an extremely low risk for the development of cervical cancer, and the risks and costs of hysterectomy are not justified in such a population. hysterectomy. A cone biopsy is performed to diagnose cancer of the cervix or to detect precancerous changes. 410-955-5000 Maryland. There appears to be a subgroup of patients (preoperative cone biopsy, tumor diameter < 2 cm) with excellent survival and low risk for recurrence after radical hysterectomy which might benefit from the advantages of laparoscopic surgery. Several previous studies have primarily demonstrated that the loop electrosurgical excision procedure (LEEP) is as safe and effective as cold knife cone (CKC) biopsy when AIS is unexpectedly found in a loop Mar 1, 2022 · If adenocarcinoma is found, this may be treated with hysterectomy (surgical removal of the cervix, uterus, and surrounding tissues) or an excisional procedure (this is a larger biopsy of the cervix, also called a cone biopsy or conization). Sep 5, 2019 · A cone biopsy is not only used to diagnose pre-cancers and cancers. Patients were Apr 24, 2018 · Background The standard treatment for cervical adenocarcinoma in situ (AIS) is hysterectomy, which is a more aggressive treatment than that used for squamous intraepithelial lesions. Cervical biopsies can be done in several ways. Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1. 855-695-4872 Outside of Maryland. May 12, 2021 · When there was inconsistency of pathological grade between colposcopy-directed biopsy, conization, and hysterectomy, the highest grade was the final diagnosis. As well as helping to make an accurate diagnosis, the cone biopsy is often an effective treatment. If too much tissue is removed during a cone biopsy so that the internal opening of the cervix to A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. 215 - 222 , 10. Jan 10, 2022 · Definition. The cervix is the lower part of your uterus. 106 Cone Biopsy: Before Your Surgery What is a cone biopsy? A cone biopsy (conization) is a type of surgery. Immediately referred to gyn/oncologist because of the AIS (the next day!) 9/10- gyn/onc performed very deep Leep cone biopsy in office - Leep results AIS and CIS with clean margins. , 305 ( 2022 ) , pp. The doctor told me if the D&C showed cancer it would require a cancer specialist to do the hysterectomy, luckily it was not cancer. Jan 17, 2022 · We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0. Over the next 2 to 3 weeks after your Jan 28, 2011 · 8/10-biopsies came back AIS and CIN II. This option may make it possible for you to consider becoming pregnant in the future. Nov 17, 2021 · A cervical biopsy is a procedure in which a small sample of tissue is removed from the cervix and the cells are examined under a microscope for abnormalities. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. 9% (2,018/18,537) of colposcopies with ECC of CIN 2 or CIN 3, cervical biopsy of CIN 3, or colposcopic impression of CIN 2+ had subsequent LEEP or cone, 96. 86, p=0. In some cases, a cone biopsy may be used as a conservative treatment for cervical cancer for women who wish to avoid a hysterectomy (surgical removal of the uterus). But it's worth asking about exact percentages and then making the decision that feels right. Recovery from a LEEP Procedure or a Cold Knife Cone Biopsy. I have CIN 3 and AIS. Typically, during a CKC more tissues are removed, which is why general anesthesia is used instead of a local anesthetic. The procedure is often recommended if a Pap test indicates the presence of abnormal cells. Avoid using tampons, douches, or medicated vaginal creams for at least 24 hours . from the cervix. Excisional procedures can be performed using a scalpel, electrosurgery (ie, loop electrosurgical excision procedure Jul 23, 2018 · Pitfalls. Want to hear real answers from people that have been went cone biopsy before uterine surgery showed improved survival over those patients having no cone biopsy (3-year RFS cone biopsy: 98. This is to confirm the diagnosis and see if there is hidden cancer that was not found by other tests. We performed a propensity matched comparison (1:1) comparing 187 patients with cone biopsy prior to radical hysterectomy with 187 without prior to cervical conization. The endocervix is the upper part that leads Feb 8, 2005 · I had a cone biopsy in May 04 and am having a hysterectomy because of stenosis of the cervix caused by the biopsy. Mar 1, 2022 · If adenocarcinoma is found, this may be treated with hysterectomy (surgical removal of the cervix, uterus, and surrounding tissues) or an excisional procedure (this is a larger biopsy of the cervix, also called a cone biopsy or conization). 3%, 24/380), and the negative rates were similar between the LEEP and cold knife cone biopsy groups (6. Sending you lots and lots of supportive thoughts and ( (hugs)). Your doctor will send the removed tissue to the lab to check and analyze it under a microscope. F. 5% (55/57) of occult cervical cancers would be detected before hysterectomy. It is not uncommon to experience some of the following unpleasant symptoms after a LEEP or Cold Knife Cone Biopsy: Feb 23, 2021 · Purpose The purpose of this study was to assess the prognostic role and the perioperative outcomes of conization performed before radical hysterectomy in early-stage cervical carcinoma. It opens into your vagina. User Guide. The endocervix is the upper part that leads Dec 6, 2023 · An endometrial biopsy is a procedure that examines the endometrium to determine the cause of abnormal vaginal bleeding or provide additional information during a fertility evaluation. I had my baby 2 months ago. Find out more about The cervical screening test or biopsy has shown abnormal glandular cells, which are the cells deep inside the cervix. INTRODUCTION Feb 11, 2022 · Cone biopsy. Initial Management. Obstet. Jul 25, 2012 · I. Jun 29, 2022 · Abdominal hysterectomy: Surgeons will make a 5- to 7-inch incision vertically or along the bikini line in your abdomen. Cone Biopsy and Hysterectomy. So I can't give an exact answer. The biopsy can remove a sample of tissue for testing. This surgery uses a scalpel or laser to remove large, cone-shaped pieces of tissue from the cervix. In 24 cases, the sample obtained by LEEP or cold knife cone biopsy was negative for dysplasia (6. According to the size of the residual tumor in the final pathology, patients were divided into three subgroups: R0 (no residual lesion), R1 (residual Jan 1, 1997 · Although frozen-section processing of cone biopsy specimens has been reported for >30 years 1, 2, 3 and has proven accuracy in experienced hands, 4, 5, 6 it is still common to await results of permanent-section histologic evaluation before proceeding with hysterectomy. During the procedure, a special lighted microscope called a colposcope magnifies the tissue that lines your cervix and vagina. Apr 27, 2022 · All patients included in the study had to have a time interval between the last diagnosis of CIN (conization or biopsy) and hysterectomy of less than 12 months, to reduce the bias related to the risk of progression of CIN in the interval between the two procedures. It removes a cone -shaped piece of tissue . Use sanitary pads for vaginal discharge. Cervical biopsies are used to diagnose cancer or precancerous cervical cells. it is still common to await results of permanent-section histologic evaluation before proceeding with hysterectomy. These include hysterectomy, cold-knife excision (also known as cold-knife cone biopsy or cold-knife conization), laser cone biopsy, LLETZ/LEEP, and other variations of electrosurgical excision, for example SWETZ, which is an alternative to LLETZ/LEEP, laser excision, or cold-knife excision when performing a type 3 excision (Camargo et al. Similarly, patients with tumors smaller than 2 cm cone biopsy Preparing for Hysterectomy (pre hysterectomy) Hysterectomy is the surgical removal of the uterus. 94, 95% CI 0. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. These procedures remove the abnormal part of the cervix rather than the entire cervix and uterus. Can Med Assoc J. Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue in a woman’s lower genital tract. The amount varies for everyone. 80 to 10. v. The incision will then be closed with staples, sutures, or surgical adhesive. There are different types of surgery to remove cervical cancer. This multi-institutional trial, led by Alan Covens, is titled “Evaluation of physical function and quality of life before and after non-radical surgical therapy (extrafascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2-IB1 (≤2 cm) cervical cancer” . 75, p=0. My doctors did the hysterectomy on the basis of need (fibroids pain bleeding and bladder issues) and did not do a biopsy. Eat well-balanced, healthy meals. A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. If AIS is identified on a colposcopic biopsy, in the absence of a visible mass concerning for invasive cancer, the next step is a diagnostic excisional procedure. 4 Secondly, our SUCCOR Cone study demonstrated that patients undergoing conization obtain a clear benefit in terms of disease-free survival (DFS) and overall survival (OS)5. Apr 14, 2024 · Cone before Hysterectomy Cancer Concerns - GYN. LEEP. PMC1830360. Sep 5, 2019 · A simple hysterectomy may be an option if the cancer shows no lymphovascular invasion and the edges of the biopsy have no cancer cells. Some pathologists in the community setting are unable to offer frozen May 28, 2008 · Hello, I have a similar situation, except I haven't yet been told I need a hysterectomy immediately. Abstract. II. 5. Request an Appointment. A second cone biopsy may be appropriate 'definitive treatment' for young women who wish to preserve their fertility if the margins of the second biopsy are clear and there is no evidence of invasion. bleeding during or after the procedure, though the tool helps seal the surrounding blood vessels to minimize this cone biopsy Preparing for Hysterectomy (pre hysterectomy) Hysterectomy is the surgical removal of the uterus. Aug 20, 2023 · Page 2- Why cone biopsy before hysterectomy? Cancer Concerns - GYN. For a very small cervical cancer, it might be possible to remove all the cancer with a cone biopsy. The specialist is concerned that the abnormal cells may have formed a very early cancer. This is also why the recovery time for a CKC is longer. Objective To evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer. Methods: This is a retrospective single-center study. Oct 15, 2008 · Maybe they just always do a biopsy before a hysterectomy when there are fibroids growing in there to make sure they are just fibroids and not cancerous so they know ahead of time it's nothing more serious. I'm sure you've been told that adenocarcinoma is considered the more aggressive cell type due to its ability to "hide" and have skip lesions which makes it difficult to catch/follow. The cervix contains two parts: the endocervix and the exocervix. Diagnosed 11/7 with adenocarcinoma in situ, I had a conization on 11/18/05 and it came back with one quadrant not having clear margins plus the upper cervical (deep margin cervix had a 'small focus of tumor present at margins of sample'). Surgeons should wait at least 6 weeks following conization or LEEP before Aug 23, 2018 · Cold knife cone biopsy is a surgical procedure that removes a small amount of abnormal tissue from the cervix for further testing. If your provider sees any abnormalities, they can take Sep 29, 2023 · Upcoming hysterectomy 3/20: Cone Biopsy the day before surgery — why? Cancer Concerns - GYN Sep 19, 2008 · The National Cervical Cancer Coalition Support Community connects patients, families, friends and caregivers for support and inspiration. My doc recommended to immediately do a cone biopsy and if I am done having children then to schedule a hysterectomy for a later date. Aug 27, 2016 · The answer might be different depending on exactly what degree of dysplasia you have; in other words, what exactly the colposcopy report said. 11/10 - Hysterectomy. If you have had a cone biopsy, the risk of giving birth before 37 weeks is about 11 in 100 (11%). Apr 19, 2024 · Why cone biopsy before hysterectomy? Cancer Concerns - GYN Hysterectomy is the surgical removal of the uterus. 11-02-2008, 06:02 PM. HysterSisters; HYSTERECTOMY. 5%, log-rank p = 0. The cone is formed by removing the outer part of the cervix closest to the vagina and part of the endocervical canal. One way is to use a surgical . It is critical to establish the depth and width of invasion to delineate microscopic stage IA1, IA2, and IB1 in order to execute the correct surgical procedure (extrafascial hysterectomy, modified radical hysterectomy, and type III radical Apr 16, 2023 · LEEP and cold knife cone biopsy had a similar rate of positive surgical margins. Objective: To evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer. The full uterus was checked for cancer after removal, all clear. Methods This multicenter, retrospective observational cohort study included patients with FIGO 2009 stage IB1 cervical carcinoma treated with radical hysterectomy between June 2004 and June 2019. The tissue removed during the cone Mar 17, 2021 · Adenocarcinoma in situ (AIS) is an HPV-associated precancerous lesion of the glandular cells of the endocervix and the precursor to endocervical adenocarcinoma. hp gk mv gy fr bt vz ye ry tk