Abstract
Objective
Pathological involvement of cervical conization margins is a risk factor for recurrence,
although management of these patients is controversial. We aimed to define risk factors
for positive margins and compare recurrence following additional surgical intervention
compared to conservative management.
Methods
A retrospective study of all conizations at our center between 2010 and 2019. Univariate
analysis identified characteristics associated with positive margins. Women were stratified
by mode of management comparing three groups (surveillance, repeat conization or hysterectomy)
then two groups (surveillance vs. additional surgery). Kaplan Meyer survival curves
compared cumulative recurrence stratified by mode of management. Pathological results
of subsequent surgical procedures were examined for residual disease.
Results
Of 448 conizations performed, 131 (29.2%) had positive margins which were associated
with menopause, high-grade cytology and endocervical gland involvement. Women who
underwent surveillance (n = 45) were more likely to be nulliparous, with low-grade
histology and less endocervical gland involvement. Women who underwent hysterectomy
(n = 61) were more likely to be postmenopausal and parous. Recurrence did not differ
significantly in the three-group (p = 0.073) or two-group model (6.4% vs. 7.1% p = 0.869).
Kaplan Meyer survival curves depicting cumulative recurrence did not differ significantly
in either model (log rank test p = 0.642 for the three-group model, and p = 0.868
for the two-group model). Residual disease was found in 51.6% of hysterectomy specimens
and 52.6% of repeat conizations.
Conclusion
Surveillance is non-inferior to additional surgery in cases with positive conization
margins and constitutes a valid option specifically for younger women at risk of future
obstetric complications and those susceptible post-hysterectomy complications.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The ATHENA human papillomavirus study: design, methods, and baseline results.Am J Obstet Gynecol. 2012 Jan; 206: 46.e1-46.e11
- ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.J Low Genit Tract Dis. 2012; 17 (2013 Apr): S1-S27
- Surgery for cervical intraepithelial neoplasia.Cochrane Database Syst Rev. 2013;
- Cold-knife conization versus conization by the loop electrosurgical excision procedure: a randomized, prospective study.Am J Obstet Gynecol. 1999; 180: 276
- Long-term mortality in women treated for cervical intraepithelial neoplasia.BJOG. 2009 May; 116: 838-844
- Risk of cervical cancer after completed post-treatment follow-up of cervical intraepithelial neoplasia: population based cohort study.BMJ. 2012; 345 (Epub 2012 Oct 31): e6855
- A randomized clinical trial of cryotherapy, laser vaporization, and loop electrosurgical excision for treatment of squamous intraepithelial lesions of the cervix.Obstet Gynecol. 1998; 92: 737
- Endocervical gland involvement by cervical intraepithelial neoplasia grade III. Predictive value for residual and/or recurrent disease.Cancer. 1991; 68: 1932
- Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis.Lancet Oncol. 2007; 8: 985
- HPV16 and increased risk of recurrence after treatment for CIN.Gynecol Oncol. 2007; 104: 273
- Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis.Lancet Oncol. 2017; 18: 1665
- Cervical intraepithelial neoplasia III: long-term follow-up after cold-knife conization with involved margins.Obstet Gynecol. 2002; 99: 193
- Incomplete excision of cervical intraepithelial neoplasia as a predictor of the risk of recurrent disease – a 16-year follow-up study.Am J Obstet Gynecol. 2020; 222: 172.e1-172.e12
- Positive margin status in uterine cervix cone specimens is associated with persistent/recurrent high grade dysplasia.Int J Gynecol Pathol. 2014; 33: 83-88
- Positive endocervical margins at conization: repeat conization or colposcopic follow-up? A retrospective study.J Clin Med Res. 2015; 7: 540-544
- Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years.BJOG. 2008; 115: 1238
- American cancer society, American society for colposcopy and cervical pathology, and American society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer.J Low Genit Tract Dis. 2012; 16: 175-204
- Menopausal status is associated with a high risk of residual disease after conization with positive margins.PLoS One. 2019; 14e0217562
- Follow-up strategies after treatment (large loop excision of the transformation zone (LLETZ)) for cervical intraepithelial neoplasia (CIN): impact of human papillomavirus (HPV) test.Cochrane Database Syst Rev. 2015; 1: CD010757
- ASCCP Colposcopy Standards: role of colposcopy, benefits, harms, and terminology for colposcopic practice.J Low Genit Tract Dis. 2017; 21: 233
- A longitudinal Swedish study on screening for squamous cell carcinoma and adenocarcinoma: evidence of effectiveness and over treatment.Cancer Epidemiol Biomarkers Prev. 2007; 16: 2641-2648
- Triage for management of cervical high-grade squamous intraepithelial lesion in patients with positive margin by conization: a retrospective analysis.Front Med. 2017; 11: 223-228
Article info
Publication history
Published online: January 25, 2023
Accepted:
January 22,
2023
Received in revised form:
January 1,
2023
Received:
November 3,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
