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Outcomes of cold knife conization according to the margin involvement in high-grade lesions and microinvasive squamous cell carcinoma of the uterine cervix

Kong, Tae Wook; Son, Joo-Hyuk; Paek, Jiheum; Chang, Suk-Joon; Chang, Ki-Hong; Ryu, Hee-Sug
Department of Obstetrics & Gynecology, Ajou University School of Medicine
OBJECTIVE : To evaluate the long-term outcome of patients with cervical intraepithelial neoplasia (CIN 2-3), adenocarcinoma in situ (AIS), and microinvasive squamous cell carcinoma of the cervix (MICA) after cold knife conization (CKC).
METHODS : We retrospectively reviewed data from 355 patients (median age 40 years old, range 21-68) with CIN 2-3, AIS, and MICA treated by CKC at a single institution between September 2003 and July 2011. Clinico-pathologic variables, including age, parity, severity of the disease in cone specimens, number of quadrant involved, ecto- and endo-cervical margin involvement, were evaluated as possible predictors of residual disease.
RESULTS : Among the 355 patients, 26 (7.3%) had residual disease demonstrated by colposcopic-directed biopsy and subsequent loop electrosurgical excision procedure (LEEP) or hysterectomy. In 244 patients (68.7%) the specimen was assessed as complete excision, and in 111 patients (31.3%) the excision was turn out to be incomplete. There were no significant differences in age, parity, and follow-up period between patients in whom excision was incomplete and those in whom complete excision was achieved. The patients who demonstrated positive margin was related to more severe disease of CKC specimens (P < 0.01), glandular involvement (P < 0.01), number of involved quadrants (P < 0.01), and residual disease (P < 0.01). The cure rate for incomplete excision at the ectocervical margin was 91.5%; incomplete excision at the endocervix was 76.7% and only 44.4% if excision was incomplete at both margins. In univariate analysis, severity of the disease in CKC specimens (20.4% [11/54] of patients with AIS and MICA vs. 5.0% [15/301] of patients with CIN 2-3, P < 0.01) and positive resection margin (18.0% [20/111] vs. 2.5% [6/244], P < 0.01) were significant risk factors for the residual disease. Multivariate analysis demonstrated that age (>50 years) (P < 0.01), severity of the disease in CKC specimens (P < 0.01), positive ecto- and endo-cervical resection margin (P < 0.01) were significantly associated with higher risk of residual disease.
CONCLUSION : CKC performed for CIN2-3, AIS, and MICA is likely to be curative when the lesion is completely excised. Most cases of incompletely excised CIN 2-3, AIS, and MICA would also be curative, even in the positive ectocervical margin. Age (>50 years), severity of the disease in CKC specimens, positive ecto- and endo-cervical resection margin could be a significant risk factor for developing residual disease after CKC.
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